Podcast appearances and mentions of lorimer moseley

Professor Lorimer Moseley is neuroscientist, who specialises in the complexities and mind-boggling nature of pain - what it is, why it exists, how it works and when it can go wrong.For most of us, pain is a fundamental part of being alive, and staying alive and yet none of us will ever experience the exact same pain as someone else, which makes it incredibly difficult to understand.Every day, we stub our toes and burn our tongues. Some of us break bones and suffer from more serious illnesses and conditions.What you feel when your skin is broken or a ligament is torn is there to tell your brain to be careful, that something is wrong and needs to be protected.But what happens when doctors can't find any damage? When the tissues in your hips or the pictures of your brain seem perfectly fine, but still, there is agonising pain that refuses to leave you alone?Lorimer was a physiotherapist who came to this very specific neuroscience after his own experience with chronic pain, following a pretty gruesome sporting injury that by all accounts had been fixed by surgery.He realised that as he was learning more about how changes in the body are detected (like temperature and pressure), and communicated as pain to the brain through the central nervous system, his own chronic pain started to diminish.Since then, Lorimer has published hundreds of papers and several books on the topic, in his pursuit to help people also dig themselves out of the hellish cruelty of chronic pain.Further informationYou can find more resources from Professor Moseley about tackling persistent or chronic pain online at TameTheBeast.orgFind out more about the Conversations Live National Tour on the ABC website.The Executive Producer of Conversations in Nicola Harrison. This episode was produced by Meggie Morris and presented by Richard Fidler. It explores persistent pain, migraine, arthritis, neurology, psychology, distrust of the medical system, pain relief, hypersensitivity to pain, doctors who believe you, chronic conditions, endometriosis.

Joining us on the show for this episode is one of the world's leading pain researchers, Lorimer Moseley, PhD. Having spent thirty plus years in his pursuit of understanding pain through the studies of neuroscience, physiotherapy, and pain science, Lorimer is currently a Professor of Clinical Neurosciences and the Foundation Chair in Physiotherapy at the University of South Australia. He's recently launched his non-profit grassroots movement called ‘Pain Revolution' which is ensuring that all Australians have access to the knowledge, skills, and local support to prevent and overcome persistent pain. For this conversation, we explore some of the key principles of his updated model of pain which draws from 50 years of research and data. It's deeply transformational work that has the potential to dramatically shift our relationship to what makes us hurt. If you wish to continue your journey into the world of pain science, head over to painrevolution.org or check out some of his lectures and Ted Talks over on YouTube. Show Topics - Lorimers Background - Central Sensitization - Pain Variability Between People - Making the Case Against the Structural Explanations of Pain - Pain is a Protective Mechanism, Not Injury Detection - Four Essential Pain Facts - Manual Therapy and Pain - Pain Revolution and Community Building - Challenging Modality Empires - Evidence Based Practice - The Social Element of Healing - What Can Those In Pain Do Right Now?

Emily had a car accident. Emily is safe and not hurt, but her car has seen better days. She was able to use what she learned writing Burnout, as well as other books and therapy to help with recovery.Let's talk about neuroplastic pain and the stress response cycle.(Do you subscribe to Emily's newsletter? ⁠You can sign up here for free⁠.)Links:FSP2025: We're Stronger Than the FireApple Podcasts • Spotify • YoutubeIn an Unspoken Voice by Peter A. Levine, Ph.D. Complete the stress response cycle - See chapter 1 of BurnoutSomatic experiencingFriendly's No Bad Parts by Richard SchwartzEmily's newsletter post about neuroplastic painThe Way Out by Alan Gordon and Alon ZivExplain Pain Supercharged by G. Lorimer Moseley & David S. ButlerCurable app

One in five people in Australia and New Zealand will experience chronic pain at some stage in their lives; and it's recognised as a major global health issue. Unrelieved pain can affect every area of a person's life with major social, financial and emotional consequences. Researchers at the University of New South Wales and Neuroscience Research Australia have done a randomised trial focusing on the experiences of people with chronic pain - and the role emotional processing plays in managing chronic pain conditions. Professor Lorimer Moseley is a professor of Clinical Neurosciences at the University of South Australia and the Chair of PainAdelaide. In this episode of Weekend One on One, he spoke with Peggy Giakoumelos on the role of psychology in chronic pain management.

In this special retrospective episode of The Thinking Practitioner, Whitney Lowe and Til Luchau look back season five's thought-provoking discussions, expert interviews, and groundbreaking insights into the world of massage therapy and bodywork. Reflecting on their most impactful episodes and a guest list that included Tom Myers, Sharon Wheeler, Jill Cook, Antonio Stecco, Greg Lehman and more, they explore highlights such as pain science with Lorimer Moseley, innovative anatomical approaches with Gil Hedley, and Til's profound personal and professional journey through grief. With a mix of deep dives into manual therapy techniques and candid personal stories, this episode celebrates the depth and breadth of the profession and the podcast's community. Key Topics and Time Codes: •[00:01:00] Introduction and celebrating five seasons of The Thinking Practitioner. •[00:04:00] Reflections on how bodywork has personally transformed Whitney and Til over the years (Episode 134). •[00:06:00] Gil Hedley's overview of cranial nerves, and his groundbreaking Nerve Tour (Episode 110). •[00:10:35] Highlights from the conversation with Lorimer Moseley on explaining pain (Episode 111). •[00:15:20] Insights into proprioception and fascia from Rochelle Clausen and Nicole Trombley (Episode 119). •[00:17:00] "Movement optimism" with Greg Lehman and rethinking rehabilitation (Episode 114). •[00:20:20] Rolfer Sharon Wheeler discusses the legacy of her ScarWork and Bone Work (Episode 133). •[00:25:00] Low back pain updates: A practical discussion on treatment and understanding (Episode 127). •[00:30:00] Reflections on grief and its profound impact on personal and professional life (Episodes 125, 130, and 132). •[00:33:00] Jill Cook's insights into tendon pain and the evolving understanding of tendinopathy (Episode 128). •[00:36:30] Celebrating the diversity of guests, their contributions to the field. •[00:38:00] Looking forward to Season 6 and inviting listener input for future episodes. Join us for a heartfelt and inspiring look back at the evolution of The Thinking Practitioner and a preview of what's to come in Season 6.

In this episode, we discuss pain science and all of its complexities. We explore: The definition of pain and chronic painPain in total knee replacement recoveryPatient and therapist expectations and their role in painPerception and awareness in painLanguage and visualisation strategies and resources in painSpinal painRole of pain in knee OAImportance of education in pain managementProfessor Lorimer Moseley is a Bradley Distinguished Professor at the University of South Australia. He is interested in pain and other protective feelings. He has written over 400 scientific articles and 7 books. His foundational discoveries and outreach initiatives have led to awards in 15 countries. He leads the non-profit Pain Revolution and in 2020 he was made an Officer Of the Order of Australia for distinguished contribution to pain and its management, education, science communication and physiotherapy, to humanity at large. He lives, works, and rides a very cool e-scooter, on Kaurna Land in Adelaide, South Australia.Associate Professor Tasha Stanton leads the Persistent Pain Research Group at the South Australian Health and Medical Research Institute (SAHMRI) and is co-Director of IIMPACT in Health at The University of South Australia, Adelaide. She is a clinical pain neuroscientist, with original training as a physiotherapist. Her research focuses on pain – why do we have it and why doesn't it go away? She has a specific interest in chronic pain, osteoarthritis, pain science education, and novel technologies, such as virtual and mediated reality, to enhance exercise engagement.If you like the podcast, it would mean the world if you're happy to leave us a rating or a review. It really helps!Our host is @sarah.yule from Physio Network

"Hvis vi anerkender, at smerte er en beskyttelsesmekanisme, og ikke et mål for vævsskade, og hvis du kan formidle det til folk, så kan vi ændre spillet" – citerer dagens godt professor Lorimer Moseley for at sige, I denne episode af "Få Det Til At Ske" dykker vi ind i, hvordan store skala adfærdsændringer kan ændre vores tilgang til et af de mest presserende sundhedsproblemer: kroniske smerter. Omkring hver femte voksne i Danmark lever med kroniske smerter.  Et problem, der ikke kun påvirker den enkelte, men også arbejdspladser og sundhedssystemet generelt. Sammen med professor Jan Hartvigsen fra Syddansk Universitet udforsker vi, hvordan ny viden om smerter nødvendiggør et paradigmeskifte både i vores personlige liv og på systemniveau.Lytterudbytter:Indsigt i smerternes verden: Forstå dybdegående hvordan kroniske smerter påvirker individer og samfundet, og hvorfor det kræver et markant skifte i både tænkning og handling.Udfordringer ved paradigmeskiftet: Lær om de største barrierer for at ændre opfattelsen af smerter hos patienter, klinikere og i sundhedssystemer.Praktiske løsninger: Få konkrete eksempler på, hvad patienter og klinikere kan gøre anderledes for at håndtere smerter mere effektivt baseret på nyeste forskning.Fremtidige perspektiver: Udforsk de potentielle positive forandringer, såsom forbedret arbejdsglæde og lavere sygefravær, der kan opnås gennem disse adfærdsændringer.  Episoden er spækket med indsigter om hvordan du kan få forandringer til at ske i forehold til at leve i og med smerter. Indsigter, der også kan bruges på mange andre adfærdsforandringer i og uden for organisationen. 

Lorimer Moseley ist fasziniert von Menschen. Er studierte Physiotherapie, Neurowissenschaften, Schmerzwissenschaften und ist Naturwissenschaftspädagoge. Nach sieben Jahren Physiotherapie kombinierte Lorimer die klinische Arbeit mit Forschung – absolvierte einen Doktortitel am Pain Management Research Institute der University of Sydney und begann sich tief in die Mechanismen von Schmerz und dessen Aussagekraft einzuarbeiten. Klaas interviewte Lorimer und versucht mit ihm eine weitere Perspektive auf das Thema Schmerz einzunehmen. Have fun!

In this episode, Til and Whitney dive into strategies for addressing low back pain (LBP) with hands-on work, exploring LBP's prevalence, causes, and treatments. Sharing the insights they've gained from experts such as Nikolai Bogduk, Stewart McGill, Paul Hodges, Lorimer Moseley, Helene Langevin and Antonio Stecco, they lay out the diverse views on both the structural and non-mechanical origins of LBP. Listeners will also learn about therapeutic approaches, the significance of practitioner confidence, and the importance of comprehensive evaluations. Tune in for a fascinating look at how practitioners and clients alike can better understand and work with low back pain. Key Topics: 1. Prevalence of low back pain Over 60-70% of people have episodes of low back pain at some point [01:51]  Leading cause of disability worldwide Huge economic impact 2. Potential evolutionary factors contributing to low back pain Transition to bipedalism and upright posture Differences in spinal curvature and hip mobility between cultures [05:45] 3. Causes and contributors to low back pain - [07:39] Overemphasis on disc and structural issues in the past Importance of comprehensive evaluation beyond just structural issues Role of soft tissue, muscular, and neural factor 4. Influence of practitioner perspective and confidence on outcomes [30:20] Importance of the therapeutic relationship and rapport Unexpected interventions can sometimes be effective [35:53] 5. Personal experiences with low back pain Overuse vs. underuse/immobility as contributors Debates about the significance of posture, load, and context [41:31] Limits of expertise vs. scope of practice for massage therapists Get the full transcript at Til or Whitney's sites!  Whitney Lowe's site: AcademyOfClinicalMassage.com  Til Luchau's site: Advanced-Trainings.com  Resources mentioned in this episode: ABMPs' CE Summit on LBP: live Oct 1, 2024 and free to everyone in the profession: abmp.com/summit Portions also available by recording to ABMP members and next year, to A-T Subscribers  Sponsor Offers:  Books of Discovery: save 15% by entering "thinking" at checkout on booksofdiscovery.com.  ABMP: save $24 on new membership at abmp.com/thinking.  Advanced-Trainings: try a month of the amazing A-T Subscription free by entering “thinking” at checkout at a-t.tv/subscriptions/,. Academy of Clinical Massage: Grab Whitney's valuable Assessment Cheat Sheet for free at: academyofclinicalmassage.com/cheatsheet About Whitney Lowe  | About Til Luchau  |  Email Us: info@thethinkingpractitioner.com (The Thinking Practitioner Podcast is intended for professional practitioners of manual and movement therapies: bodywork, massage therapy, structural integration, chiropractic, myofascial and myotherapy, orthopedic, sports massage, physical therapy, osteopathy, yoga, strength and conditioning, and similar professions. It is not medical or treatment advice.)

I am happy to have Dr. Lorimer Moseley AO back in this episode of the Healthy, Wealthy, and Smart podcast. In this episode, Lorimer shares insights into his recent research projects and developments in pain science. We discuss the Fit for Purpose model and the evolution of pain education, emphasizing the importance of educative interactions in clinical practice. Tune in to learn more about Lorimer's current projects and his upcoming classes in North America. Time Stamps:  00:00:00 - Introduction and Welcome Lorimer is welcomed back to the podcast, and the host expresses excitement about discussing his recent projects and developments since 2021. 00:01:09 - Exciting Discoveries in Recent Research Lorimer discusses the nature of discoveries in clinical science, mentioning upcoming publications and the streams of research that currently excite him, particularly in pain education. 00:02:04 - Insights from Clinical Practice and Pain Education Lorimer shares insights from clinical practice data, highlighting significant findings about patient outcomes related to their understanding of pain as a protective feeling. 00:04:05 - Learning About Learning The importance of learning in clinical interventions and its impact on treatment outcomes is discussed, emphasizing the need to shift focus from education to learning. 00:06:39 - Upcoming Clinical Trial Publication Lorimer teases a forthcoming paper on a clinical trial for chronic back pain, detailing the innovative approach taken in the trial to improve treatment credibility and effectiveness. 00:10:56 - Research on Social Determinants of Health Discussion shifts to the impact of social determinants on health outcomes, with specific focus on back pain and the broader implications for treatment accessibility and effectiveness. 00:16:31 - Pain Revolution Outreach and Challenges Lorimer talks about the Pain Revolution program, its goals, and the challenges faced in reaching rural communities, especially during the COVID-19 pandemic. 00:27:21 - Cognitive Flexibility in Pain Management The concept of cognitive flexibility is explored, discussing its relevance to pain management and the challenges in accurately assessing it. 00:39:43 - Personal Experience with Pain and Cognitive Flexibility The host shares a personal story about dealing with potential pain triggers at Disneyland, highlighting the role of cognitive flexibility and support in managing pain responses. 00:50:22 - Recap and Future Directions The conversation wraps up with a recap of the discussed topics, emphasizing the complexity of pain management and the ongoing efforts in research and education to improve patient outcomes.   More About Dr. Lorimer Moseley AO: DSc PhD FAAHMS FACP HonFFPMANZCA HonMAPA  Bradley Distinguished Professor Professor of Clinical Neurosciences Foundation Chair in Physiotherapy University of South Australia Founder and CEO, Pain Revolution Chair, PainAdelaide  Lorimer's main interests are persistent pain and other protective feelings. His research group investigates pain in humans, from cognitive and behavioural experiments to clinical trials and implementation studies. He has authored over 410 scientific articles and seven books. His contributions to the science of pain, to the treatment of persistent pain, to pain education, and to public outreach, have been recognised by honours in 13 countries. He has delivered keynote lectures at world congresses in six fields. In 2017, he founded the non-profit Pain Revolution and in 2020 he was made an Officer of the Order of Australia, that country's second highest civilian honour, for ‘distinguished served to humanity at large in the fields of pain and its management, science communication, education and physiotherapy.' His public facing pain education videos attract millions of views each year. He lives and works on Kaurna Land in Adelaide, South Australia.   Resources from this Episode: Pain Revolution Website Fit For Purpose Model Pain Science in Practice Courses in North America   Jane Sponsorship Information: Book a one-on-one demo here Mention the code LITZY1MO for a free month     Follow Dr. Karen Litzy on Social Media: Karen's Twitter Karen's Instagram Karen's LinkedIn   Subscribe to Healthy, Wealthy & Smart: YouTube Website Apple Podcast Spotify SoundCloud Stitcher iHeart Radio

World leading neuroscientist, pain researcher and educator, Prof. Lorimer Moseley, discusses the complex relationship between our minds, our bodies and pain.

"Welcome to Pain Matters, the podcast where we delve into the latest advancements and discussions surrounding pain treatment and management. Join us as we explore insightful conversations with leading experts like Professor Lorimer Moseley, who shares invaluable insights into improving outcomes for chronic pain patients. From understanding the evolution of pain treatment to addressing challenges and areas for improvement, each episode offers a deep dive into the complexities of pain management. Discover how clinical trials and multimodal approaches are reshaping the landscape of pain care, and gain practical insights on translating scientific knowledge into effective clinical strategies. Whether you're a healthcare professional, researcher, or someone living with chronic pain, Pain Matters provides a platform for meaningful discussions and actionable takeaways. Tune in and stay informed about the latest developments in pain treatment on Pain Matters."   Questions: mail@mastersessions.academy Bookings: http://mastersessions.academy  

Welcome to another insightful episode of Pain Matters! In today's episode, we dive deep into the clinical course of back pain, a topic that affects many of us at some point in our lives. Professor Lorimer Moseley, who sheds light on a groundbreaking clinical course with a staggering 10,000 participants. The study meticulously divides patients into two categories: those experiencing back pain for less than six weeks and those enduring it for more than six weeks. The focus? Recovery chances.  A recent meta-analysis by Dr. Sarah Wallwork, utilizing data from a massive 20,000 people, unveils not two but three distinct groups. The twist? The definition of chronic low back pain has been extended to three months and beyond. This shift in perspective brings both good and challenging news. The revelation? After the three-month mark, the odds of recovery take a significant hit. While some of this might not be entirely surprising to the experts, it's a revelation that carries weight, especially for the general public. The question lingers: Is the three-month cut-off the definitive marker for chronic low back pain? Well, that's still an unanswered puzzle. But hold on, there's good news too. In the midst of uncertainties, Professor Moseley unravels some positive aspects. Curious to know more? You don't want to miss this episode! Tune in and let's explore the fascinating world of back pain together.

Pain Matters Episode 8 features hosts Lorimer Moseley and Bart van Buchem interviewing their guest, Brian Pulling. Brian, an American researcher finishing his PhD, shares insights into a research project focused on understanding how individuals think about pain, specifically in the context of osteoarthritis. The episode delves into the development of a questionnaire to explore people's conceptualizations of osteoarthritis pain. Brian emphasizes the importance of face validity in questionnaire development and shares insights from cognitive interviews, highlighting diverse perspectives on pain. The conversation, hosted by Lorimer Moseley and Bart van Buchem, provides valuable insights into the complexities of understanding and measuring pain experiences.

Welcome back to another insightful episode of "Pain Matters" with Lorimer Moseley! In this follow-up episode, we're delving deeper into Pain Hyper Sensitivity, building on the thought-provoking discussions from our previous installment that sparked numerous reactions and questions from our engaged audience at mail@mastersessions.academy. Join us as we explore the clinical presentations and diagnostic properties related to Pain Hyper Sensitivity. Lorimer sheds light on the examination process and provides explanations that aim to demystify this complex topic. Recognizing the need for clinicians to identify patterns, Lorimer emphasizes the importance of initiating conversations, not just through words but also by employing experiential learning strategies. Ever wondered how to effectively convey these concepts to your patients? Lorimer shares insights on what works, what doesn't, and the significance of understanding these nuances in patient care. As we approach the end of the year, let's reflect together and gather inspiration to fuel ourselves for a promising 2024. Wishing you all happy holidays, and we can't wait to continue exploring exciting topics with you in the coming year. Stay tuned and keep the curiosity alive!   Check our website for early bird tickets - A two-day LIVE course in York (UK) on 14 and 15 June 2024

Welcome to a new episode of the Pain Matters Podcast, where we dive into the intricate world of pain science with leading expert Professor Lorimer Moseley to explore the concept of pain system hypersensitivity. In our journey through the realms of pain, we encounter terminology that seeks to capture the essence of patients' experiences. One such term, "pain system hypersensitivity," emerges from a meticulous study where patients themselves were asked to articulate their ongoing pain states. In this episode, we unravel the significance of this term, delving into its connections with primary and secondary hyperalgesia, as well as allodynia. The introduction of "pain system hypersensitivity" stems from a profound understanding of patients' perspectives and preferences. As we navigate through this discussion, we will explore how this term reflects the lived experiences of individuals grappling with persistent pain. Interestingly, alternatives like "nociplastic pain" and "oversensitivity" were considered but did not resonate with the patients. Our exploration today aims to shed light on the intricacies of pain system hypersensitivity, offering insights that could reshape our understanding of chronic pain and guide us towards more empathetic and effective approaches to pain management. So, join us on this enlightening journey with Professor Lorimer Moseley as we delve into the nuanced world of pain system hypersensitivity on the Pain Matters Podcast.

Pain can be felt anywhere in the body, but it all originates in the same place: the brain. Lorimer Moseley, a professor of clinical neurosciences at the University of South Australia and a specialist in how the brain produces pain signals, joins us today to talk about how pain is created as a protective strategy. Your brain, which is constantly monitoring your environment for signs of danger vs safety, sends pain signals when it detects a painful stimulus (a process called nociception).  Moseley studies how to retrain the brain when it continues to send pain signals long after the damaged tissue has healed (or, in the case of phantom pain, even after the damaged tissue is gone).  Plus - the dangers of a pain-free life.

We apologize for the inconvenience caused due to some audio issues in the first uploaded episode. We have fixed the problems, so you can now listen to the relaunched episode without any unexpected volume differences. Thank you for your patience and understanding. Did we get lost in translation with Central Sensitization? Professor Lorimer Moseley dives into the history and today's implications of this important scientific finding.    - Introduction to Central Sensitization: The podcast episode delves into the concept of Central Sensitization and its impact on pain research and education. It's discussed as a significant shift in understanding pain mechanisms. - Historical Context: Clifford Woolf is mentioned as a significant figure in identifying the changes in sensitivity within the central nervous system, sparking extensive research to understand the mechanisms behind it. - Challenges in Terminology and Definition: There's a discussion about the terminology challenges and conflation between physiological events and clinical labels regarding Central Sensitization. The debate revolves around its definition and how it's observed in humans, with attempts made in brain imaging to comprehend its effects. - Complexity of Pain Perception: The discussion highlights the complexity of pain perception, mentioning that the idea of specific labelled neurons in the 'pain pathway' (nociceptive pathways) might not hold true due to the intricacies of the nervous system and individual variability in response to stimuli. - Evolution of Understanding Pain: The talk explores the evolution in understanding pain, moving towards concepts like neuroimmune networks and the acknowledgement of the limitations of defining Central Sensitization, leading to the consideration of new terms such as nociplastic pain for clinical findings.  

Yes, your pain is all in your head - but that doesn't mean it's not "real". Dr. Lorimer Moseley, author of the best selling classic "Explain Pain" is a trailblazer in the field of contemporary pain science.   In our next episode he explains how all pain is real, but you can train your mind to understand what each pain "means", and choose how to experience it.  

“ … it's really fascinating actually like the human, at the biological level at the psychological level, we are built to tolerate pain, and we're built to grow stronger from enduring difficulty, we're actually made for it. That's like how it works. Joy matters too - don't get me wrong, you know, but the difficult stuff is always there. So, we might as well get good at utilizing that end of the spectrum as well.” Ralph De La Rosa   Music with kind permission from Krishna Das https://www.krishnadas.com/ Gathering in the light-Om-Narayani. Krishna Das. https://krishnadasmusic.com/collections/music/products/gathering-in-the-light   What is this and why read or listen? What follows is an exploration of my journey of living with chronic pain and accompanying mental health challenges. I now understand, the experience of mental ill health has contributed to the degree and severity with which I have felt this pain.   I started collating my thoughts around the idea of exploring chronic physical pain, and how meditation might help as an intervention to assist people living with these conditions, to experience less suffering. As we will discuss in a bit, pain, whether is physical, emotional, or social, is experienced in similar parts of the brain. So is you know someone who experiences any of these challenges, there may be something in here that might help.   So primarily, we will look at how using a meditative practice might help to reduce suffering, reclaim access to moments of joy and openness and foster the ability to be able to pursue a life worth living, in the presence of pain. Someone once sent me a post on social media with a picture and a quote saying “Life is not about waiting for the storm to pass. It's about learning to dance in the rain.” I was near vomiting with a migraine at the time, so there was no dancing to be done and the message was not received with the love it was sent with.   I think it's important to mention that there is no part of my life that living with chronic pain has not affected. I remember sitting in a psychologist's office on the North Side of Brisbane, and I was quiet for quite a while, trying to curate the thoughts so that I could adequately relay how desperate I felt, but not so much so that I have a short involuntary time in hospital. The words that came out of my mouth spoke to the total sense of loss that I felt as a result of living with chronic pain and the ‘things' that I was not able to do or participate in as a result – “Am I even lovable?” I choked out, in tears. I am not sure what my psychologist answered.   In mental health circles they often talk about the biopsychosocial contributors to understanding mental ill health, and that a clear understanding of these can be the bedrock to solid recovery. It's fair to say and not at all dramatic to say that living with chronic pain for the last 14 years has nearly cost me my life, my marriage, and my grip on sanity. So, the fact that I am writing this, and that this episode is being produced is testament to the fact that recovery is definitely possible.   Recovery as I've come to understand it is a concept which is defined by each person as to how they might like to live despite the challenges they face, be they mental health, chronic physical health or other challenge.   Having a living experience of chronic and persistent pain, has also come with many gifts. This is one of the reasons for this episode - I would like to be able to pass these gifts forward so that hopefully, wherever you are on your journey, whether it's living with chronic pain, mental health or other challenge, that you may find a point of resonance here and maybe a tool that you can add to your toolkit. The second reason is that this forms part of an assessment for an advanced diploma in meditation. Having skin in the game as it were, I feel like I may have a bit of an advantage, by way of lived experience. However this works meets you, may you be well, play be happy may you be safe and may you live at ease of heart with whatever comes to you in life.   “What counts in battle is what you do when the pain sets in.” John Short   The quote above comes from a book that I read about 14 years ago from Dean Karnases called Ultra Marathon Man. In the book Dean talks about nearing the end of one of the ultra marathons, that he ran, with several injuries and nothing left in the tank. Dean's dad offers some advice and empathy, but as he's about to walk away he says “what counts in battle is what you do when the pain sets in”. This has become somewhat of a guidepost for me,  as I explored the terrain chronic physical and emotional pain.   Towards the end, I will include a selection of resources and links. In hosting the Don't Quit on Me podcast, I have spoken with a variety of subject matter experts, in an effort to understand ways to navigate intense stress and pain, in the most intelligently, i.e with the least amount of suffering possible.   A key point from the show comes to mind, talked about by Dr Dan Harvey and Insight Meditation teacher Sebene Selassie, about the experience of emotional, social pain and physical pain being processed in similar parts of the brain. In my very limited understanding, this means that tools that help to reduce suffering for physical pain, may also be useful for the experience of social and emotional pain.   Skin in the Game   “It is indeed a radical act of love just to sit down and be quiet for a time by yourself”. Jon Kabat-Zinn   It's just after 4am and the birds are starting to sing. First one … then another… during the dawn chorus their songs seem louder, livelier and more urgent than during the day. Maybe they seize this space to sing, before the noise of the day can interrupt their beautiful, melodic songs that call each day in to being.   I am awake at this time most mornings. This morning a sequence of experiences; a conjoined blur - pain from a decent tension headache that has been hanging around for days, coupled with pain from fibromyalgia, panic and it's cousin a dense cognitive fog – the residue of a nightmare – I still sense, something dark, very close, too close to see, temporarily I can't move.   As consciousness returns, and with-it, limited movement, I go through the morning ritual, an attempt to ease the pain and fog, and see how much I am able to function and extract from the day. Off to the loo, two bottles of water and then into a portable infrared sauna, to warm up the heaviness living in the muscles and connective tissue, and with any luck subdue the constant companion. Infrared Sauna is also starting to be looked at as a tool for living with chronic pain conditions. (Tsagkaris et al., 2022)   I have a living experience with chronic migraines, tension headaches and fibromyalgia, something that has been around for roughly the last 14 years. Each day is a balancing act between the pain, the anxiety caused by the pain, my energy levels, and as I am beginning to understand and will touch on later, any sense of imminent danger that I may perceive. Each day, an attempt to balance accomplishment without overtaxing a system in survival mode, so much that I pay for it for the coming days.   There are a couple of reasons why the pain may have become such a permanent fixture in my life, and I'll explore them briefly, but one thing I have noticed, is that focusing on why is nowhere near as helpful as what now. If I look back for a point of origin with the physical pain several things happened around the time it started; my mom's passed away, I also trained for a marathon, before which I came down with a respiratory virus. Post race I had blood work done which showed Ross River virus and another virus had been present in my system but were not currently active. I am also a survivor childhood trauma which in and of itself heightens someone's baseline perception of threat and as we'll explore can accentuate and amplify the body's attempt to report pain signals. There is also a strong correlation between trauma survivors and chronic pain sufferers (Asmundson, PTSD and the experience of pain: Research and clinical implications of shared vulnerability and mutual maintenance models).   In 1994 Dr Paul brand wrote the book Pain the Gift That Nobody Wants, describing his work with leprosy patients in India, and the essential role that pain has in keeping us safe. Without , he argues, we would be exposed to an unacceptable level of danger, leaving us devoid of mechanisms to warn us of impending threat.   If I think about my own experience, this is certainly a truism - pain by its very nature, and the way we experience it, is deeply unpleasant, very real, and is designed to get our attention and cause us to recoil. It is a message for us to act, to protect ourselves from the perceived threat. What happens through, when these signals fall out of calibration, when they report pain too loudly or for too long - when there is no longer a present threat that requires us to act, or the message we are receiving is disproportionate to the threat?   This is something I have sat with and worked through for many years, leading to this exploration of how the practice of meditation may be helpful to those, like me, who live with chronic pain.   As I said earlier, through hosting the Don't Quit on Me podcast I have had the opportunity to ask many people for their insights about the nature of pain, and why creating mental space around the experience of pain can reduce suffering. I have also looked at the links between how we experience physical pain and emotional pain, and how they are felt in similar parts of the brain.   Can meditation really help with pain? An article published in May 2023 on Healthline.com, looked at exactly this, Meditation for Chronic Pain Management and, spoiler alert, they found, amongst other things, the following three key points:   “A 2018 study of meditation, mindfulness, and the brain suggested that in the long term, meditation can change the structure of your brain. The resulting change in cortical thickness in some brain areas makes you less pain-sensitive. The neural mechanisms meditation uses to modify pain are different from those used by other techniques. For example, a 2012 studyTrusted Source determined that meditation promoted cognitive disengagement and an increased sensory processing of the actual pain. Meditation also induces the body's own opioid system. A very small, randomized, double-blind study from 2016 used the opioid blocker naloxone or a placebo and studied pain reduction with meditation. The group with the placebo experienced significantly less pain than the group that had the opioid blocker. Research is ongoing to look at the exact physiological mechanisms involved with meditation.” (Hecht, 2020)   That Sounds Painful   What is Pain?   Dr Dan Harvey is a Lecturer in Musculoskeletal Physiotherapy and a pain scientist at the University of South Australia.  Along with Dr Lorimer Moseley, Dan is an author of the book 'Pain and The Nature of Perception: A New Way to Look at Pain' which uses visual illusions to describe features of perception that are relevant to understanding and treating pain. Dan holds a Masters of Musculoskeletal and Sports Physiotherapy, a chronic pain focussed PhD, and serves on the education committees for the Australian Pain Society and Pain Revolution. Below is and excerpt from my interview with Dan (Coriat, Dr Daniel Harvey - The path through pain 2022): I asked Dan about his preferred definition for pain. Dan said “ the official definition from the international association for the study of pain, “Pain is an unpleasant, sensory and emotional experience associated with actual or potential tissue damage.”” He went on to say: “... I prefer a simpler definition, which is just something that's unpleasant that has a location to it. The location part is what distinguishes pain from other unpleasant experiences. I guess anxiety for example is very unpleasant, but you can't point to it. You know, you could simplify my definition even further … It's (pain) something unpleasant you can point to. Because it's certainly unpleasant, but it's unique from other unpleasant experiences, in that it actually has a location, usually in the body, but obviously the exception to that is something like phantom limb pain. You can still point to the pain, but you are effectively pointing in mid air. Because you're experiencing it in a location of the body which no longer exists.”   The Mental and Psychological Experience of Pain   I asked Dan about the similarities between psychological and physical pain. “There's a lot of overlap. … one of the early discoveries when we started using imaging techniques to see what was happening in the brain of people in pain, was that we discovered that there is no one pain area, but rather it's many different areas that seem to be active. And there's something about that combination of brain areas that gives rise to the experience. Many of those areas that are active overlap with areas associated with anxiety and fear and other unpleasant experiences. And I guess that's one reason why we might see a higher prevalence of persistent pain problems in people who tend to be higher in trait, anxiety and depression, and maybe even have clinical levels of anxiety and depression. We think there's some sense in which brain areas that are active, and resulting in anxiety, facilitate the networks associated with pain and sort of have this facilitating effect.   On this point, when I spoke with much loved Insight Meditation teacher Sebene Selassie, I asked her the following question (Coriat, Dr Daniel Harvey - The path through pain 2022):   Nick: “I've heard you say in an interview. You were talking about the pain you experienced during cancer, and how it started to become a predictive response, you would feel some pain and you would assume that that would continue, and it would be without break. However, when you deepened your practice, you discovered that you could find spaces between the pain. Could you talk about this. And also, I think if there's a link to how many of us are experiencing pain, and when we do feel pain, obviously there's an instinctual response to assume it's going to be ongoing and be to kind of self-medicate...”   Sebene: “I could talk about physical pain, and just to name that this is true for social pain as well, because actually, our brains process them in the same way. So physical pain and social pain are processed in the same parts of the brain. So, you know, our perceptions of them are really similar and so predicated on what's happened in the past. You know, we build kind of our perceptual reality based on what we've seen before. So, you know, I have a mic in front of me, if I've never seen a mic before, you know, but then I learned what it is every time I see something shaped like this, I'm going to assume it's a mic, and I don't have to kind of go through the relearning process to figure it out. Our brain kind of builds up that knowing something, and that's useful for a lot of things, but it's not very useful in kind of a moment-to-moment sensory experience of a sensation or emotion, or, other people's emotions or speech or relationship with us. And so again, whether it's physical pain or social pain, like our interactions with others, we really want to develop, through this capacity of mindfulness, of embodied awareness of what's happening, the capacity to sense what's happening moment to moment. Instead of, you know, I see Nick and the last time Nick and I met, you know, we had a little bit of a misunderstanding, and now I'm going to interpret every different look of his as some kind of critique of me. Rather than meeting you fresh and deciding, you know, Nick has bad days too, and I'm gonna see what today brings rather than the assumption of, you know, what my experience has been in the past.  And that's what I experienced with physical pain that I went through some periods of really, really painful surgeries or treatments or emergency conditions that emerged in my body and even lying in the hospital or at home experiencing this pain, I could kind of predictably assume, oh, there's that sensation in my belly. I know what that's going to lead to. And so, start to kind of almost anticipate and tense and create more tension and pain and not really have a moment to moment kind of intimate experience of what was happening. And when I could slow down, actually connect to this embodied awareness, feel the sensation in my belly, I could see that, Oh yeah, it's this throbbing strong pain, but now it's actually dissipated.  When I breathe really deeply, actually it creates some space there and now my foot's going numb. I actually don't even really feel this pain in my belly right now. So, rather than having kind of this fixated fear, tense attention to things there internally our own physical or emotional experience, or externally what's going on with someone, we kind of create more spaciousness, create kind of more awareness, bring some relaxation and ease to what's happening, and that can often change everything for us.”   The Mechanisms of Pain   Back to the chat with Dan, I asked him if there was a simple way to understand the mechanisms that drive or report the experience of pain. “I'm not sure if there's a simple way, but a way we like to break it down in the physio program is thinking about inputs, processing and outputs. So, what this does is just let you think about the different components that might be happening in the background that lead to an experience of pain. The input is (comprises) the information that arrives at the brain, so some of that information comes through nerves in the body. Some of it also comes through our eyes and ears, because our brain is always gathering data, about what's happening in our bodies and what's happening in the world. So, we can refer to those things as inputs. Of course, information from the body is really important, particularly in acute pain. But the other inputs are also really important. I could give an example there. A paper cut might hurt extraordinarily, but someone could actually fracture a bone in their foot, in a football game and not notice it. So, there's something about the totality of data, not just the information itself from the body, but what it's combined with at a given time. So that's the inputs. The processing is about what's happening in the brain. So, how is the brain interpreting that data, and how's it making sense of it. In order to make sense of it, the brain considers not just the inputs, but also, what those inputs mean with respect to information that's already stored in the brain, from past experience, from knowledge, from what the doctor told you, from what you read on a scan, all of these things are also influential, when the brain is interpreting what's happening in the body. So, all of those things can potentially have an influence as well. So that's inputs and processing. Then we can think about outputs. And these days we actually think about pain as an output because anatomical textbooks used to describe pain as an input from the body in the quote unquote pain nerves, which we now call nociceptors or danger detectors. But the pain isn't pain until we experience it. And so, because of that fact, we tend to think of it as an output. My physio students always say an output to where though? And I think that the best way to phrase that is it's an output from our brains into our conscious awareness -  and that's much more philosophical than it is scientific, but I think we know so little about the brain that sometimes philosophy is the best way to explain and articulate these sort of things. You know, pain exists amongst a range of outputs. So often when you have pain, you also have some level of fear about it. You might have muscle tension associated with it, along with stress responses, go hormonal responses like cortisol, and then that can interact with the immune system. And so what's happening there can then feed back into the system in a sort of circular way.”       Reality leaves a lot to the imagination.   I asked Dan about a quote that iI heard him make in a lecture “Reality leaves a lot to the imagination. ” I think some background to this is that the brain is bombarded with so much sensory information at a given time, that it needs some sort of method to make sense of all that data, because there remember what comes to the brain from our sensors is merely electrical impulses. It's  (the brain's) task is to filter out the irrelevant ones and make sense of the relevant ones. What seems to seems to be happening is the brain uses its past experience and knowledge that it already has stored to determine what's the irrelevant information that it can filter out, and how it might make sense of the relevant information and give us feelings and perceptions that help us make sense of the world and our bodies and help to guide our actions in a way that you know, helps us to flourish and promotes our survival and all that. So again, it's quite, it's quite philosophical … I think there's still a lot to be drawn out of that way of thinking that can help people with pain. I think we are really just at the start of that. I guess it's only fairly recently that we've moved from continuing to look for some ‘Magic bullet' or some specific problem in the body. We've started to open our minds to looking more broadly about what's happening in the immune system and in the brain and our perceptual system more broadly.”   A New Reality? Based on what Dan was saying it's interesting to also note that a study in 2018 at Harvard showed that short daily doses of meditation can literally grow the grey matter in the areas of the brain associated with self-awareness and self-compassion, and can reduce the grey matter in the parts of the brain associated with stress. This to me and, obviously to the researchers is incredibly promising for those who are walking a path accompanied by pain of any kind - that a no/low cost intervention, that is simple to instigate, with little known side effects, can have this profound an effect. (Powell, Harvard researchers study how mindfulness may change the brain in depressed patients 2018) What is Meditation?   Meditation sort of hit me in the face in the late ‘90s. I was working at a bank at the time, as a technical writer, and was experiencing what I have now come to understand as early signs of a severe depression episode. I wondered up the Queen Street mall in Brisbane, and there was a Virgin Music Store off to left. In there they had listening stations with a selection of some of the newest CDs to have a listen to. This lunch break I felt like I was about to break. I made my way in to the classical room which was sectioned off from the rest of the store by a glass wall. On one stand was a CD by a fella called Robert Gass, singing, with his choir, Om. The primordial syllable over and over for about 30 minutes. As I pushed passed the initial boredom, I was transported to a world where things were calm, still and all that was present was this moment. What is meditation? Well, it depends on who you ask. After having asked many people for definitions of what meditation and mindfulness are one definition of Mindfulness shared by Dr Christine Runyan I loved for it's simplicity and humanness. Christine is a clinical health psychologist, Professor in the Department of Family Medicine and Community Health at the University of Massachusetts Medical School, and the Co-Founder of Tend Health. Christine is also a mindfulness teacher at the University of Massachusetts Centre for Mindfulness. I asked Christine during the show how she defines Mindfulness, and what it meant to her: (Coriat, Dr Christine Runyan - Mental Health and covid - On Forgiveness and Healing 2021) Christine: “So, I define mindfulness both as present moment awareness, but I add the quality of compassion, if you will. You know compassion is often a term we think of around the presence of suffering.  All our present moment experiences don't include suffering, so in moments where there are, I would say present moment with awareness with compassion, and maybe if there's not suffering, present moment awareness with kindness. I think that standard Jon Kabat-Zinn definition is without judgment. I find that whether you're parenting a child or sort of teaching an animal something, offering something to do rather than not to do can be a little more helpful right? So instead of don't do this, rather offer an instruction of something to do, and I've really come to that. And in my work, MBCT is a treatment for people who have recurrent depression and there is amount of judgment and self-judgment that comes alongside recurrent depression and experiencing that phenomenon. And so it can be a hard stop, cause it's sort of like they don't have a frame for how to be in a way that doesn't include self-judgment, so instead kind of an invitation to sort of have that present moment awareness with kindness can be an invitation of something to add rather than something not to do, because as soon as you sort of have that without judgment and people notice that they judge, you know then you start down the rabbit hole of judgment. So that's how I define it.”   Another description about what meditation is, comes from one of my favourite Buddhist teachers Pema Chodron. “Meditation is a process of lightning up, of trusting the basic goodness of what we have and who we are, and of realising that any wisdom that exists, exists in what we already have. We can lead our life so as to become more awake to who we are and what we're doing rather than trying to improve or change or get rid of who we are or what we're doing. The key is to wake up, to become more alert, more inquisitive and curious about ourselves.” There are a couple of points that I particularly like about what Pema said: 1)     We are already wise, despite what our inner monologue may tell us, and the limitations that the experience of being in pain has led us to believe. 2)     Many of us are sort of asleep to what's going on in our lives. This is understandable in the presence of persistent pain. One of the initial ways to deal with the constant onslaught of noxious stimuli is to literally disassociate from what's going on in the body. A critical part of the healing journey Is to become aware of the sensations in our body and learn to meet them with curiosity instead of an inbuilt narrative and catastrophizing. 3)     Curiosity and not self-condemnation is one of the keys to loosening the shackles of self-imposed suffering.   And lastly, I feel that no discussion on a definition of meditation would be complete without a word from one of the founders of insight meditation in the West. Sharon Salzberg is a meditation pioneer, world-renowned teacher, and New York Times bestselling author. She is one of the first to bring mindfulness and lovingkindness meditation to mainstream American culture over 45 years ago, inspiring generations of meditation teachers and wellness influencers. I spoke with Sharon in November of last year and asked her what is the invitation that meditation offers.   “Well, right from the beginning, I am going to introduce the idea of meditation as a skills training.  And the first night of the first retreat, (that Sharon attended) which is 10 days long, he said, the Buddha did not teach Buddhism. The Buddha taught way of life. And that's exactly what I was looking for. You know, he said, this is open to anybody. Maybe you belong to a different faith tradition. Maybe you don't really, feel drawn to faith traditions. Doesn't matter, it's a practice and, and it's like a muscle group. You exercise, you know, So the first skill is really concentration or stabilizing attention somewhat. Most of us would say we're kind of all over the place. You sit down to think something through, and you're gone, you're just gone. And our minds jump to the past, or the future and we're anxious and we're just all over the place. And what we do in concentration training, as we gather our attention, we bring it together and we rest, we settle. So, there's a very different sense of centeredness and settledness and just kind of stability in awareness. And then there's mindfulness training, which is kind of like the word of the hour, which can mean many different things. It does mean many things. And I like to think of mindfulness as a quality of awareness where our attention to what's happening in the present moment, our perception of what's happening in the present moment is not so distorted by bias, like old fears - I should never let myself feel this thing. Or many times something happens, especially let's say, it's discomfort in the body, or we feel a shattered expectation, or we feel disappointment, or heartache. We start projecting it into the future. Like, what's it gonna feel like tomorrow? It'll be even worse. What's gonna feel like next week? What's gonna feel like next month? And before we knew it, we've got like a whole lifetime of anticipated struggle as well as what's actually going on right now - that makes it of course, much harder. So, there are a lot of ways in which we have filters or we have distortions of our perception and what we learn to do is relinquish the hold of those things so we're left with what's actually happening and that's why mindfulness is set to be the vehicle for inside understanding. You know, instead of being all caught up in like fighting our experience or being overwhelmed by our experience, we can take a look at our experience and have a very different view of it and mixed up in there always both as a kind of a constituent element and later as a fruition or a benefit is loving kindness or kindness. I don't think you can actually do these practices well without, in a sneaky way, developing some loving kindness, even if it's never talked about. It's like, the fundamental exercise in many systems. Even if they grow and they change and it becomes a much more elaborate kind of practice. The foundational note, which we keep coming back to again and again, is usually choosing an object of awareness, like I'd say the feeling of the breath, the sensation of the in and out breath, resting our attention on that object, and then when our attention wanders, which it will, learning how to gently let go and come back. That sounds easy. Isn't that easy? You know? Because the great temptation as soon as we realize, oh, I'm not with the breath, is to judge ourselves and be down on ourselves, and berate ourselves and feel like a failure. You know, to actually let go and start over means there's a good degree of self-compassion that's developing also, even if we never name it that, even if we didn't even realize that it's happening, and so, to do any of these things well means that's cooking also. So, it will be there, it has to be there. And then of course it is like a fruition because the more we see, yeah, this is not just me, you know, it's like that sense of isolation was another addon. There was something else I plopped on top of what was going on. I don't need to do that. The more we see this is the human condition we're all trying, we're all kind of a mess, you know? Uh, and we wish ourselves well. We wish others well. That starts to get more and more natural.”   My Journey with Meditation    I first started a meditation practice through attending a yoga class. I was having a chat with the teacher at the end of the class, and I asked her for some tips on navigating the pain and suffering that I was going through, without overdoing it. She asked if I had experienced Kirtan before. I hadn't but heard in her explanation the word meditation, and this was something I wanted to explore more, as my sister had sent me a copy of the Jon Kabbat Zin book Full Catastrophy Living a few years earlier and the promise of stillness or calm inside stressful moments was very appealing. At the time I had an orange VW bus which I drove up to a yoga school just on the outskirts of Eumundi and enjoyed one of the strangest and yet most profound evenings that I've ever had. I was both fearful and intrigued, and at one point was wondering whether it should be experienced closed or eyes open, so as not to miss what was going on. As I closed my eyes, I could see a white light connecting all of our foreheads together. Powerful and strange. Given that this was my first ‘go' at it, I made my excuses and jumped in the van to go home, a little bit freaked out but pleasantly so. In retrospect I wonder what might have happened if I'd stayed. However I listened to a CD that I had bought from the studio at the beginning of the chant, all the way home and was instantly hooked. I bought a couple of yoga magazines and found out that Krishna Das was coming to Australia, immediately booked in for a workshop and Kirtan on two separate days at Palmwoods on the sunshine coast in QLD. Again I started the weekend in a decent amount of pain and experiencing very high levels of anxiety and severe depression, however by the end of the weekend I was beaming and felt such a strong bond to the people who I had been chanting with. It was quite unfathomable. I have a beautiful picture of myself with Krishna Das at the end the weekend. For many years mantra repetition became my default meditation. Something that I could pull out of my back pocket whether I was at work at home or out and about, a non pharmaceutical intervention that helped to center me and bring me out of the tyrany of cascading thoughts and more in to this moment – the only moment in which we have any say about what goes on. Many years later I interviewed KD for a book and he mentioned a quote by the Indian sage Ramana Maharishi; He said ‘“The only freedom we have is in the moment. How we meet each moment, how we meet each experience.” All the practices we do, bring us more into the moment, give us more of a sense of confidence in ourselves, and in just being. And from that deeper place, we can meet all the difficult things that come to us in life and all of the wonderful things that come to us in life, without being totally washed away by them or absorbed in them or lost in them. We can enjoy the beautiful things and we can allow the unhappy things to exist and pass away again.'   Now it's probably imprtant to clarify, mostly for my own understanding as I mix the two up, the difference between Kirtan and bhakti. Kirtan and bhakti are both related to the devotional singing of mantras, sacred names or praises of the divine. However, they are not exactly the same.   Kirtan is a form of call-and-response chanting that involves a leader and a group of participants. The leader sings a line of a mantra, and the group repeats it back. Kirtan is usually accompanied by musical instruments such as harmonium, tabla, mridanga, etc. Kirtan is a way of expressing love and devotion to the divine through sound and music. Kirtan can also help to cut through the illusion of separation and connect to the heart and the present moment.   Bhakti is a Sanskrit word that means “love, devotion, faith, loyalty, attachment”. Bhakti is one of the paths of yoga that focuses on cultivating a personal relationship with the divine through various practices such as kirtan, bhajan, japa, puja, etc. Bhakti is also a philosophical and theological concept that describes the nature of devotion and surrender to the supreme reality.   One of the differences between kirtan and bhakti is that kirtan is a specific practice or technique of bhakti, while bhakti is a broader term that encompasses various forms of devotion. Another difference is that kirtan is usually performed in a group setting, while bhakti can be practiced individually or collectively. A third difference is that kirtan follows a structured format of call-and-response, while bhakti can be more spontaneous and creative in expressing one's feelings and emotions.   KD also says of chant more generally ““It's like an older, deeper, bigger being. It's a space, a presence, a feeling. These names are the names of that place inside of us that is love, pure being, pure awareness, pure joy.” Kirtan—and other forms of mantra practice, such as seated meditation—help us uncover that place inside of us, he says: “our true nature.” (Kripalu Centre for Yoga and Health, 2021)     Over the follwing years I have adopted a fluid approach to meditation, utilising practices from Vedic, Buddhist and some secular Mindfulness traditions, and varying types of breathwork grounding and awareness of sound meditations. The important point to mention here is, I feel that, as a person living with pain, the last thing you probably need in your life is another stick to beat yourself with about what you should be doing. I think if the promise of a clamer mind, less catastrophising and less pain resonates with you, look for and try something that makes sense, or feels good you. Or more eloquently from the Buddha's teachings: “Do not believe in anything simply because you have heard it. Do not believe in anything simply because it is spoken and rumoured by many. Do not believe in anything simply because it is found written in your religious books. Do not believe in anything merely on the authority of your teachers and elders. Do not believe in traditions because they have been handed down for many generations. But after observation and analysis, when you find that anything agrees with reason and is conducive to the good and benefit of one and all, then accept it and live up to it.”     Self Compassion   Before we have a go at a practice to draw this to a close, it's essential to add a point that I touched on very briefly before, and that's the point of self-compassion. The most succinct way I've heard described, was by Liz Stanley: “I would just say it's really important (for listeners) to recognize that one of the ways we actually make things worse for ourselves, is when we let our thinking brains judgments about what might be going on in our mind and body, kind of get stuck because those judgements actually make things worse. So, to give an example, if somebody is experiencing chronic pain, and they're feeling self-judgment, or shame, or impatience, or anger, about the fact that they are feeling chronic pain, that kind of judgment and any narrative that the thinking brain might be kicking up around it ‘it shouldn't be this way', you know it was doing better, I should have done my exercises, any sort of stories that might be there, when the thinking brain does that, the survival brain perceives those thinking brain judgements as threatening. And so, it turns on even more stress arousal. So, if someone's experiencing discomfort and then they're judging it, they're actually making that stress arousal. Likewise, we often have habits to compare what's going on in us with someone else. Like we might experience a wave of anxiety about an upcoming test or something. And then the thinking brain's like, well, I shouldn't be anxious about that, that's not really a big deal. You know, this other person, well, they're dealing with this and this and this and this in comparison, what I'm dealing with is really not a problem. You can hear the judgment in that. And when the thinking brain starts, those kinds of comparing thoughts that devalue what's going on in our body, again, the survival brain finds that challenging, and it will turn on more stress arousal. So as much as possible, if someone is experiencing a wave of emotion or a wave of stress or defaulting to engage in a coping mechanism that they might not want to be engaging in, a habit they wish they could break - as much as possible just meet that experience with some kindness, and see if you can set that judging aside, because the judging is only making it worse. It's only making the, the survival brain that much more amped up.” (Coriat, Dr Christine Runyan - Mental Health and covid - on forgiveness and healing 2021)   That's the last thing I really wanted to say, Nick, because I know it's something I really struggled with”   Practice     References   Music throughout the podcast Das, K. (2007). Gathering in the light-Om-Narayani. Krishna Das. https://krishnadasmusic.com/collections/music/products/gathering-in-the-light   Other References Haggai et al, S. (2016, July). Mindfulness meditation modulates pain through endogenous opioids. The American Journal of Medicine. https://www.amjmed.com/article/S0002-9343(16)30302-3/fulltext Zeidan et al., F. (2023, February). Disentangling self from pain: mindfulness meditation–induced pain relief is driven by thalamic–default mode network decoupling. Journal for the International Association for Pain. https://journals.lww.com/pain/Fulltext/2023/02000/Disentangling_self_from_pain__mindfulness.8.aspx Powell, A. (2018, August 27). Harvard researchers study how mindfulness may change the brain in depressed patients. Harvard Gazette. https://news.harvard.edu/gazette/story/2018/04/harvard-researchers-study-how-mindfulness-may-change-the-brain-in-depressed-patients/   Tsagkaris, C., Papazoglou, A. S., Eleftheriades, A., Tsakopoulos, S., Alexiou, A., Găman, M.-A., & Moysidis, D. V. (2022, March 14). Infrared radiation in the management of musculoskeletal conditions and chronic pain: A systematic review. European journal of investigation in health, psychology and education. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8946909/   Hecht, M. (2020, September 4). Meditation for pain relief: What to know & how to try it. Healthline. https://www.healthline.com/health/meditation-for-chronic-pain   Asmundson, G. J. (2022, December 2). PTSD and the experience of pain: Research and clinical implications of shared vulnerability and mutual maintenance models. Canadian journal of psychiatry. Revue canadienne de psychiatrie. https://pubmed.ncbi.nlm.nih.gov/12553128/   Coriat, N. (2022, October 20). Dr Daniel Harvey - The path through pain. Don't Quit on Me. https://www.podpage.com/dont-quit-on-me/dr-daniel-harvey-the-path-through-pain/   Coriat, N. (2021, March 11). Sebene Selassie - belonging in an age of disconnect. Don't Quit on Me. https://www.podpage.com/dont-quit-on-me/s1e3   Coriat, N. (2021, December 31). Dr Christine Runyan - Mental Health and covid - on forgiveness and healing. Don't Quit on Me. https://www.dontquiton.me/dr-christine-runyan-mental-health-and-covid-on-forgiveness-and-healing/   Center for Yoga and Health, K. (2021, July 11). The Beginners' Guide to Kirtan and Mantra. Kripalu. https://kripalu.org/resources/beginners-guide-kirtan-and-mantra

In this enlightening episode of the MasterSessions Pain Matters Podcast, join renowned pain researcher Lorimer Moseley and the Bart van Buchem as they delve into the fascinating story of Lorimer's early career in the world of pain research. Lorimer shares his unexpected path from being a physiotherapy student to becoming a respected academic, all thanks to a motivating lecturer who saw his potential. Discover how a chance clinical encounter with a senior academic changed the course of Lorimer's career, leading him into the realm of scientific research. Listen in as Lorimer reflects on the pivotal moment he crossed paths with David Butler, a prominent figure in manual therapy, and how this encounter reignited his passion for exploring the complexities of pain management beyond the traditional biomechanical perspective. Explore the origins of Lorimer's first scientific paper during his PhD journey and how it laid the groundwork for his ongoing contributions to the field of pain research. Discover the enduring relevance of his early work and the insights that continue to shape our understanding of pain today. Whether you're an aspiring researcher, clinician, or simply curious about the evolution of pain science, this episode offers a captivating glimpse into the roots of Lorimer Moseley's extraordinary career. Tune in to uncover the rich history of pain research and gain valuable insights for your own journey in the field.   More about Lorimer and courses: https://www.mastersessions.academy/ Comments, feedback and questions are welcome! mail@mastersessions.acedemy    

The inaugural episode of the "Pain Matters Podcast" with Professor Lorimer Moseley, titled "Why Pain Matters," delves into the profound significance of pain in our lives and society. Professor Moseley explores the multifaceted impact of pain on individuals, communities, healthcare, and research funding. Pain touches the lives of countless individuals, affecting not only those who experience it but also their loved ones, colleagues, and communities. The discussion highlights the far-reaching implications of pain, encompassing reduced quality of life, social isolation, decreased productivity, and its association with various health conditions. Despite pain being a significant contributor to disability and suffering, it often receives inadequate attention and funding compared to other health issues. Professor Moseley draws inspiration from two triggers: the Pain Revolution rural outreach tour and preparing a grant application. The Pain Revolution tour exposes the immense need for pain education and management in rural communities, demonstrating that pain is often undertreated. Furthermore, the grant application process reveals a broader issue: the prevailing but outdated beliefs about the nature of pain, hindering progress in pain research and treatment. The podcast aims to challenge these entrenched views and initiate conversations about pain's complexity, its psychological aspects, and the need for a paradigm shift in understanding and addressing chronic pain. Professor Moseley, with his extensive background in physiotherapy and neuroscience, is committed to exploring the intricacies of human pain perception, the brain's role, and how society perceives and responds to pain. In future episodes, the podcast promises to delve into the history of chronic pain research and share insights from Professor Moseley's extensive experience in the field. With an emphasis on demystifying pain and advocating for a more comprehensive understanding, "Pain Matters with Lorimer Moseley" aims to contribute to the ongoing conversation surrounding pain and its impact on individuals and society. Check out: https://www.mastersessions.academy/   #PainMatters #ChronicPain #PainAwareness #PainManagement #Neuroscience #HealthPodcast #PainRelief #PainEducation

This is the 'Why Pain Matters' Podcast - with Lorimer Moseley So, from now until whenever, we will be covering matters of pain and why pain matters. Short, hopefully interesting accounts of things I reckon are important or fascinating or challenging or troubling. I will enjoy it and I really hope you do too! I am not too sure on where exactly to start – there is so much good stuff going around. If the podcast goes down well we might start taking requests, And on that, I have wondered about the marker of success and I guess, as much as I am resistant to the modern penchant for soliciting followers and ‘influence', I imagine that some combination of feedback, use and reach will be relevant. I am sure, however, that the most relevant marker will be whether or not this is adding to my life, not yours. Don't mean to sound harsh, but that is, for me, the metric of choice. About Lorimer: I want you to know the bare minimum relevant facts about me. I have an honours degree in physiotherapy, a phd in neuroscience. I have been interested in chronic pain for about 35 years and have engaged with it from lived experience, clinical care, research and advocacy perspectives.   I am fascinated by humans – I suspect I always have been – and I find biological systems and governing principles extraordinary and very very cool. I believe that understanding things is worth the effort and accepting things we don't understand is completely ok if we are neither bothered by it nor shirking it because it is too hard or inconvenient. I have a deep respect for the capacity with which we are all endowed to automatically protect ourselves and our loved ones, even when the strategies we select – or that are selected for us by our fearfully and wonderfully complex biology, end up being less than ideal or counterproductive. More info about Lorimer courses: https://mastersession.academy      

Lorimer's excitement in both work and life stems from a profound interest in the challenge of chronic pain. The more he learns about the workings of pain, including the biological processes involved and the experiences people go through, the more he is captivated by the complexity of this issue. The complexity of pain is awe-inspiring, highlighting the incredible nature of human beings. Recent advancements in pain research have revealed that the degree of complexity is far greater than what was previously believed a decade ago. Professor Lorimer Moseley is a highly respected and renowned figure in the field of pain science and neuroscience. He has made significant contributions to our understanding of chronic pain and has played a crucial role in challenging traditional beliefs and perceptions surrounding this complex phenomenon. Lorimer obtained his academic qualifications at the University of South Australia, where he completed his Bachelor's degree in Physiotherapy. He then went on to earn his Ph.D. in the field of neuroscience from the University of Sydney. Throughout his academic journey, Lorimer developed a deep fascination with pain and its intricate mechanisms. As a leading expert in the field, Lorimer has held prominent positions at various prestigious institutions. He has served as a Professor of Clinical Neurosciences and the Inaugural Chair in Physiotherapy at the University of South Australia. Additionally, he has been involved with the Body in Mind research group, which focuses on advancing our understanding of pain and rehabilitation. Lorimer's groundbreaking research and innovative approach to pain science have garnered widespread recognition. He has published numerous influential papers in scientific journals and has authored and co-authored several books that have become authoritative resources in the field. Through his work, Lorimer challenges conventional theories and encourages a more comprehensive understanding of pain as a complex biopsychosocial phenomenon. Beyond his academic achievements, Lorimer is known for his engaging and passionate teaching style. He frequently presents at international conferences, delivers captivating TED talks, and provides educational workshops to healthcare professionals. His ability to translate complex scientific concepts into accessible language has made him a sought-after speaker and educator. #chronicpain #lorimermoseley #complexity

Is "Pain weakness leaving the body" or is pain an indication that something is wrong? According to Dr, Lorimer Moseley - neither! Dr. Lorimer Moseley is a pain scientist, educator and clinician. He has authored over 400 scientific articles and seven books. His contribution to our understanding of how pain works, why pain sometimes persists, and what can be done to reduce persisting pain, has been recognised by awards or prizes in 14 different countries. In 2020 Dr. Moseley was made an Officer of the Order of Australia, his country's second highest civilian honor, for 'Distinguished service to humanity at large in the fields of pain and its management, science communication, medical education and physiotherapy." He lives and works in Kaurna County in Adelaide, South Australia. //TIMESTAMPS (00:00) Pain: It's not what you think! With Dr. Lorimer Moseley (04:00) Jon leads Opening Grounding Practice (~1 min) (07:00) Acknowledging and honoring the Kaurna people (08:00) What exactly is pain? (21:00) Pain is in the brain (36:00) The Protect-o-meter! (43:00) Mindfulness and pain (55:00) Why are we attached to pain? (1:10:00) Will leads Closing Practice (~ 1 min) //LINKS Pain Revolution - https://www.painrevolution.org/ Tame the Beast - https://www.tamethebeast.org/ Dr. Moseley's books - https://www.noigroup.com/shop/ //WHERE YOU CAN FIND US Website - http://mentalkingmindfulness.com/ Listen on Spotify - https://bit.ly/MTM-Podcast Listen on Apple Podcast - https://bit.ly/MTM_Apple_Podcast Watch on YouTube - https://youtube.com/@mentalkingmindfulness Instagram - https://www.instagram.com/mentalkingmindfulness Follow Will - https://www.instagram.com/willnotfear/ Follow Jon - https://www.linkedin.com/in/jonmacaskill Join the MTM Facebook Group - https://www.facebook.com/groups/153173176744665

Tim Beames is the co-founder of Le Pub Scientifique and also co-author of the Graded Motor Imagery (GMI) Handbook alongside Lorimer Moseley and David Butler. Tim talks about what GMI is, how this has changed over the years, what attributes a clinician needs to use GMI with a patient and where research is taking us in the evolution of GMI. If you want to become really confident treating pain join us with Le Pub Premium Membership. Sign up at www.lepubscientifique.com  If you'd like to get in touch with Le Pub here's how: Email: lepubscientifique@gmail.com Twitter: @lepubscientifiq Instagram: @lepubscientifique LinkedIn: @LePubScientifique Join the Le Pub Community on Facebook: Le Pub Scientifique   

Physical pain is a universal human experience. And for many of us, it's a constant one. Roughly 20 percent of American adults — some 50 million people — suffer from a form of chronic pain. For some, that means having terrible days from time to time. For others, it means a life of constant suffering. Either way, the depth and scale of pain in our society is a massive problem.But what if much of how we understand pain — and how to treat it — is wrong?Rachel Zoffness is a pain psychologist at the University of California, San Francisco, School of Medicine and the author of “The Pain Management Workbook.” We tend to think of pain as a purely biomechanical phenomenon, a physical sensation rooted solely in the body. But her core argument is that pain is also produced by the mind and deeply influenced by social context. It's a simple-sounding argument with vast implications not only for how we experience pain but also for how we treat it. She points to numerous underused tools — aside from pills and surgeries — that can help lessen our pain.We discuss Zoffness's surprising definition of how pain serves as “the body's warning signal”; how our mood, stress levels and social environment can amplify or dial down our pain levels; what phantom limb syndrome says about how the brain “makes pain”; how our emotions and trauma influence our pain levels; the crucial difference between “hurt” and “harm”; why studies on back pain have yielded such bewildering results about the sources of perceived pain; how to figure out and improve your personal “pain recipe”; the roots of our chronic pain crisis and how our health care system could be better set up to treat it; why she says, “If the brain can change, pain can change”; and more.Mentioned:“Neuroimaging of Pain” by Katherine T. Martucci and Sean C. Mackey“Targeting Cortical Representations in the Treatment of Chronic Pain” by G. Lorimer Moseley and Herta Flor“Psychological Pain Interventions and Neurophysiology” by Herta Flor“Sham Surgery in Orthopedics” by Adriaan Louw, Ina Diener, César Fernández-de-las-Peñas and Emilio J. Puentedura“Systematic Literature Review of Imaging Features of Spinal Degeneration in Asymptomatic Populations” by W. Brinjikji, P.H. Luetmer, B. Comstock et al.“A Biological Substrate for Somatoform Disorders: Importance of Pathophysiology” by Joel E. Dimsdale and Robert Dantzer“Undergraduate Medical Education on Pain Management across the Globe” by Nalini Vadivelu, Sukanya Mitra and Roberta L. Hines“Lifestyle medicine for depression” by Jerome Sarris, Adrienne O'Neil, Carolyn E Coulson, Isaac Schweitzer and Michael BerkBook Recommendations:Why Zebras Don't Get Ulcers by Robert M. SapolskyThe Body Keeps the Score by Bessel van der KolkPain by Patrick WallThoughts? Guest suggestions? Email us at ezrakleinshow@nytimes.com.You can find transcripts (posted midday) and more episodes of “The Ezra Klein Show” at nytimes.com/ezra-klein-podcast, and you can find Ezra on Twitter @ezraklein. Book recommendations from all our guests are listed at https://www.nytimes.com/article/ezra-klein-show-book-recs.“The Ezra Klein Show” is produced by Emefa Agawu, Annie Galvin, Jeff Geld, Roge Karma and Kristin Lin. Fact-checking by Michelle Harris and Kate Sinclair. Mixing by Sonia Herrero and Isaac Jones. Original music by Isaac Jones. Audience strategy by Shannon Busta. The executive producer of New York Times Opinion Audio is Annie-Rose Strasser. Special thanks to Carole Sabouraud and Kristina Samulewski.

This episode I talked about how our experience with pain is influenced by psychological factors and the complexity of the human body/ brain. My own injuries and experiences with pain have allowed me to understand my own experience with anxiety more and I find it incredible how our brains/ bodies work. This episodes quote: Your body can't stand almost anything. It's your mind you have to convince. Links to the videos mentioned: Lorimer Moseley's Ted Talk https://www.youtube.com/watch?v=gwd-wLdIHjs Mysterious Science of Pain https://www.youtube.com/watch?v=eakyDiXX6Uc

In session 101 Lorimer Moseley stated "Nociception is neither sufficient nor necessary for pain" There was a good deal of pushback on social media regarding this and Asaf Weisman has stepped up to discuss why that is. Jack and Asaf discuss nociception from an evolutionary stand point and why this is important, they then go on to discuss the brain centric nature of research. Its a complex evolving conversation and one thing everyone can agree on is definitions need to be agreed upon! Sponsored by rehabmypatient.com get 3 months free exercise prescription and virtual appointment software HERE

Lorimer Moseley's Quiz for Clients About Pain Science OT Elevate: The Biopsychosocial Approach to Colorectal ConditionsLindsey's NewsletterTed TalksPredictive Processing as a Theory to Understand Pain with Mick ThackerWhy do we hurt? by Professor Lorimer MoseleyPodcasts One Thing pain podcast with Mick ThackerPain Science and Sensibility with Sandy Hilton & Cory BlickenstaffThe Healing Pain podcast by Dr Joe TattaBooksExplain Pain by David Butler and Lorimer Moseley The Explain Pain Handbook: Protectometer by Lorimer Moseley & David Butler.  Permission to Move by Dave Moen and Farrin FosterOther ResourcesReal Stories of RecoveryThe Neuroscience of Creativity, Perception, and Confirmation Bias with Beau LottoFree course in mindfulness is offered by Monash UniversityZiva Meditation  

Take a look in the mirror! Have you ever used mirror box therapy to help restore normal movement patterns? Join us where we reunite with Miranda Materi OTD, OTR/L, CHT from Phoenix, AZ discuss how Mirror Box Therapy can help with many different diagnoses from amputations to CRPS and even just stiffness. Miranda dives into how Mirror Box Therapy can be built at home in a “do it yourself” fashion or references where to buy a Mirror Box Kit. Please refer below for newer research articles found to support use of Mirror Box Therapy with your hand patients! CRPS and Mirror Box G. Lorimer Moseley, Alberto Gallace, Charles Spence, Is mirror therapy all it is cracked up to be? Current evidence and future directions, PAIN,Volume 138, Issue 1,2008,Pages 7-10, ISSN 0304-3959 https://doi.org/10.1016/j.pain.2008.06.026. (https://www.sciencedirect.com/science/article/pii/S0304395908003710) Amputees and Mirror Box Timms, Jason, and Catherine Carus. "Mirror therapy for the alleviation of phantom limb pain following amputation: A literature review." International Journal of Therapy and Rehabilitation 22.3 (2015): 135-145. Stroke and Mirror Box Thieme H, Morkisch N, Mehrholz J, Pohl M, Behrens J, Borgetto B, Dohle C. Mirror therapy for improving motor function after stroke. Cochrane Database of Systematic Reviews 2018, Issue 7. Art. No.: CD008449. DOI: 10.1002/14651858.CD008449.pub3. Accessed 05 October 2022. Hand Trauma and Mirror Box Grünert-Plüss, Nicole, et al. "Mirror therapy in hand rehabilitation: a review of the literature, the St Gallen protocol for mirror therapy and evaluation of a case series of 52 patients." The British Journal of Hand Therapy 13.1 (2008): 4-11.

Daniel is a Lecturer in musculoskeletal physiotherapy and a pain scientist at the University of South Australia. His research focuses on new approaches to chronic pain that leverage new technologies and modern understandings of body-related perceptual processes. Along with Lorimer Moseley, Daniel is an author of the book 'Pain and The Nature of Perception: A New Way to Look at Pain' which uses visual illusions to describe features of perception that are relevant to understanding and treating pain. Daniel holds a Master of Musculoskeletal and Sports Physiotherapy, a chronic-pain focused PhD, and serves on the education committees for the Australian Pain Society and Pain Revolution. https://www.noigroup.com/product/pain-and-perception/ Twitter Close Support the show

WE ARE BACK, we said we would do some special episodes and we absolutely couldn't turn away the opportunity to interview the one and only Lorimer Moseley who is, of course, an absolute legend. You won't get an interview with Lorimer like this anywhere else. - Is nociception necessary for pain? - Is pain a sensation or a perception? It is all answered and a whole lot more!

In episode 380 of the Mechanical Care Forum, we're continuing with season 12 and we're spotlighting important books related to our field of conservative care of musculoskeletal disorders. This week we have Dr. Lorimer Moseley and his book, Explain Pain, a book to educate patients about their pain. We talk about where the idea of this book came with his coauthor David Butler, the principles found within the book, who needs to hear it, some related projects, and other books associated with this effort to help people make their way out of persistent pain and plenty more. To hear the entire episode go to your favorite podcast player or go to www.mechanicalcareforum.com

More stories, wisdom, encouragement, and helpful strategies for anyone with chronic pain, from musician Chrissy Van Dyke, coach Alex Bollag, psychotherapist Lisa Jones and medicinal herbalist Clare McQuade.  If you suffer with chronic pain you're not alone, and there is hope...Part 2 of 2Profanity warning: occasional swearingIn order of appearance:Chrissy Van Dyke, musician and Alexander Technique teachersoundcloud.com/chrissyvandyke(If you would like help with chronic pain, the following three practitioners  offer different, all excellent and highly recommendable services)Psychotherapist Lisa Joneslisajonescoaching.co.ukAlexandra Bollag, coaching for people with chronic painalexandrabollag.comClare McQuade, medicinal herbalist: stoneroot.life/herbal-medicine---Further useful information from pain expert Professor Lorimer Moseleytamethebeast.org

Lorimer is Bradley Distinguished Professor in Clinical Neuroscience, Foundation Chair in Physiotherapy and Director of IIMPACT in Health at the University of South Australia. His main interests are persistent pain and other protective feelings. His research group investigates pain in humans, from cognitive and behavioral experiments to clinical trials and implementation studies. He has authored over 350 scientific articles and seven books. He has received international awards for his contributions to the science of pain, the treatment of persistent pain, to pain and health education, and for his public outreach initiatives. In 2017 he founded the not for profit Pain Revolution and in 2020 he was made an Officer of the Order of Australia, that country's second highest civilian honor, for ‘distinguished served to humanity at large in the fields of pain and its management, science communication, education and physiotherapy.' He lives and works on Kaurna Land in Adelaide, South Australia.

This is a replay of the listener-favourite podcast with the pioneer Professor Lorimer Moseley to supplement the other podcasts released on chronic pain.  Enjoy! Professor Lorimer Moseley is a clinical scientist investigating pain in humans. After posts at The University of Oxford, UK, and the University of Sydney, Lorimer was appointed Professor of Clinical Neuroscience and Chair in Physiotherapy at the University of South Australia. He is also Senior Principal Research Fellow at NeuRA and an NHMRC Principal Research Fellow. He leads the Body in Mind Research Group, based at the University of South Australia which investigates the role of the brain and mind in chronic pain.  He has published over 310 papers, six books for clinicians and patient workbooks, and numerous book chapters/. He is a strategic adviser for PAIN, associate Editor for the Journal of Pain, the European Journal of Pain and the British Journal of Sports Medicine. More "pain" info, including websites mentioned, videos, images and courses at https://thegpshow.com/bookshelf/painmedicine/ Interested in studying lifestyle medicine, health coaching and new models of care in health and wellbeing?  Check out the JCU postgraduate courses: Grad Cert, Grad Diploma, and Master.  If you find this podcast valuable then subscribing, sharing, rating it 5 stars and leaving a review is appreciated. If you would like to provide feedback or request a topic, please contact me via thegpshow.com  Thank you for listening and your support.

Lorimer is Bradley Distinguished Professor in Clinical Neuroscience, Foundation Chair in Physiotherapy and Director of IIMPACT in Health at the University of South Australia. His main interests are persistent pain and other protective feelings. His research group investigates pain in humans, from cognitive and behavioral experiments to clinical trials and implementation studies. He has authored over 350 scientific articles and seven books. He has received international awards for his contributions to the science of pain, the treatment of persistent pain, to pain and health education, and for his public outreach initiatives. In 2017 he founded the not for profit Pain Revolution and in 2020 he was made an Officer of the Order of Australia, that country's second highest civilian honor, for ‘distinguished served to humanity at large in the fields of pain and its management, science communication, education and physiotherapy.' He lives and works on Kaurna Land in Adelaide, South Australia.

My guest today is Leanne Rath! (FACP) Leanne a is  physiotherapist practicing at Physiosports, Brighton, Melbourne Australia.  She is sought after as an educator and mentor to the profession. She is a keynote in the Physiosports Education platform and is an invited speaker on Lorimer Moseley's MasterSessions later in 2022, an online worldwide pain conference exploring “Less Pain, Better Performance” She is currently involved in projects through the University of South Australia, Tash Stanton's Knee Osteoarthritis & Pain Education Trial and is working in partnership with researches at Victoria University who have experience in athlete mental health and well being, as a Clinical Investigator, exploring Pain and Performance in lifeShe has held an Adjunct Fellow position at The University of Queensland (2016-2019) exploring the function of Adductor Magnus in gait and hip/groin rehabilitation exercises. She is passionate about athlete-centred care and finding common ground in contemporary clinical and coaching approaches.Leanne has worked with the Australian Ballet and the Australian Institute of Sport (1995-2005), and many of Australia's highest performing athletes as a Sports Physiotherapist which included her time as a member of the Australian medical team at the Olympic Games (Sydney 2000) and the Commonwealth Games (Manchester 2002).She is passionate about athlete-centered care and finding common ground in contemporary clinical and coaching approaches.If you like today's episode, leave a review here....If you want to reach me directly, contact me on social media or shoot me @javier@igniteperformance.netEpisode Resources:Leanne's Twitter Physio Sports Website Leeane's WebsiteLess Pain Better Performance Website Leanne's publication on the Adductor MagnusLeeane's email : leanne@physiosports.com.auResearch ArticlesEmbodied Predictive Pain Processing Theory of Pain Credits: Song- "Starstruck" by Freebeats.io 

Rajam Roose, a massage therapist and founder of the San Diego Pain Summit, comes onto the HET Podcast to speak about her interest in pain treatment and research, as well as, explain how she was able to bring her dream conference to fruition. Biography: In 2014, Rajam Roose (a massage therapist with an interest in pain treatment and research) was organizing interdisciplinary continuing education workshops for manual and physical therapists in San Diego. During a break at one workshop, she overheard the instructor asking the participants if they were learning current pain research in their programs. If they were familiar with pain research experts such as Patrick Wall, David Butler, Lorimer Moseley, etc. The students nodded their heads, and one spoke out and replied: "Yes, we were taught current pain research at my school but I have no idea how to apply it into my practice."  Rajam realized there needed to be an event where participants could learn clinical applications of pain research that would be directly relevant to their work. Without any prior experience organizing or managing a conference, Rajam created this multidisciplinary pain management conference and found success from the start. Over the years, the San Diego Pain Summit has evolved into an event where clinicians learn how to have a person-centered practice. View the historical list of all speakers/presentations. The San Diego Pain Summit is on a mission to change how pain is managed and treated in the healthcare industry by organizing conferences and workshops where clinicians can learn up to date pain education and research. The Summit also includes voices representing the patient's lived experience, which is an integral part of creating person centered care.

In this episode I discuss why back pain is such a debilitating injury and the statistics behind it, the difference between acute and chronic back pain, what the "best" recovery routine is and then a 5 step simplified process of the road to recovery from chronic back pain.Below are the two links I was referring to in the episode, both by Professor Lorimer Moseley who is a clinical scientist investigating pain in humans.Why Things Hurt Ted TalkPain LectureTake My FREE Pain Quiz And Get An Instant Action Plan... so you know EXACTLY what to do to fix your ache, niggle, pain or injury: https://resiliencerehab.com.au/free-pain-quiz/Fix Even The Most Complicated Ache, Pain Or Plateau... at a FRACTION of the cost of 1-1 coaching... https://resiliencerehab.com.au/free-pain-quiz/Join My Private Email List... for all updates and bonus education/content: https://resiliencerehab.com.au/email-list/Take Advantage Of Your FREE Complimentary Strategy Call... to bridge the gap between where you are and where you want to be: https://calendly.com/resiliencerehab/pain-codex-strategy-call

Dr. Ebonie Rio is a post doc researcher at La Trobe University and has completed her PhD in tendon pain and a Masters in Sports Physiology. She is a leading researcher in tendon pain and rehab at La Trobe University in Australia.She drops tons of knowledge in this episode including the types of load that can irritate tendons, the importance of single leg training, Lorimer Moseley's questions around self efficacy, ways to explain the murky ups and downs that come with tendon pain, and more! Listen in for a number of clinical pearls on diagnosis and treatment for simplifying these complicated issues. Find her on twitter at https://twitter.com/tendonpainAs always, find more information about courses at https://www.mwri.co and follow us on Instagram to keep up with Clinical Leadership Podcast updates!PS: Please help us grow our youtube channel! Like and subscribe HERE!

A 3-day conference in San Diego, during a wet and miserable February back home in England? Where do we sign up?! Yes, Matt has managed to finagle his way to attending the 2022 San Diego Pain Summit - but what is it, and why is it such an important conference? Rajam Roose, former massage therapist and founder and CEO of The San Diego Pain Summit, joins The Massage Collective to fill us in on the history of the summit - how it grew from the need for an event where participants could learn clinically relevant applications of pain research, how getting the first years Keynote speaker (Lorimer Moseley!) was a game changer, how the evening hot tubs and fire-pits result in amazing connections (we're looking at you Adam Meakins & Ben Cormack's Better Clinician Project!), plus how this years summit is shaping up to be the most interactive yet - whether you are there in person or joining online from the comfort of your sofa. The back catalogue of talks hosted on the SDPS website is worth its weight in gold, but the aspect that makes this summit so unique is the opportunity for attendees and speakers to network and learn from each other in a relaxed atmosphere like no other. We highly recommend joining the virtual conference! You can contact Rajam and find out more here; Facebook Twitter

Find out how the pain signal works and learn how to start retraining your brain today. I guide you through a short exercise to help you feel these ideas and get in touch with other, better options for your nervous system.Plus I share some real stories of real people and how this plays out in their very real lives. Don't take my word for it. Listen to these ideas and try them on for yourself in your own life. Put it all to the test and see the results. Leave a comment or question and let's have a conversation!(To watch Lorimer Moseley tell the story of his experience with pain and the snake go here https://www.youtube.com/watch?v=Sjes9CuN6Ko)If you are interested in being one of the 3 people I take on to work with this month, email me at: molly@movetonourish.comOTHER KEY INFODownload Your Free Self-Assessment: Is Your Pain Triggered By Your MindJoin our Free Facebook Community, From Pain To Empowerment: https://www.facebook.com/groups/frompaintofreedom/Follow me at: https://www.facebook.com/movetonourishCheck Out Our Website: https://www.movetonourish.com/

On this episode of the Healthy, Wealthy and Smart Podcast, Dr. Michael Weinper speaks with guest host Dr. Stephanie Weyrauch about the American Physical Therapy Association's Vision 2020. Passed by the House of Delegates in 2000, Vision 2020 was APTA's plan for the future of physical therapy. In his 2000 Dicus Award speech, Dr. Weinper discussed his predictions of where the profession would be in 2020. Dr. Weinper and Dr. Weyrauch revisit the elements of Vision 2020 and analyze whether our profession has accomplished a vision of the future set twenty years earlier. In this episode, we discuss: -How has the physical therapy profession evolved since the drafting of Vision 2020? -The student loan debt to income ratio -Advocacy efforts to achieve full direct access in all of the States -The importance of lifelong learning and evidence-based practice -And so much more! Resources: Stephanie Weyrauch Instagram Stephanie Weyrauch Twitter Stephanie Weyrauch Facebook Email: sweyrauchpt@gmail.com APTA Website A big thank you to Net Health for sponsoring this episode! Learn more about Four Ways That Outpatient Therapy Providers Can Increase Patient Engagement in 2020! For more information on Dr. Weinper: Michael Weinper, PT, DPT, MPH, cofounded the company in 1985 with his partner, Fred Rothenberg, a former executive at Blue Cross of California. A physical therapist with more than 40 years of experience in clinical practice, management consulting, administration, and program development, Weinper is also a principal in Progressive Physical Therapy, a private practice, with four locations in Southern California. Weinper received a Bachelor of Arts degree in Industrial Psychology and a Bachelor of Science degree in Health Science (physical therapy) from California State University, Northridge. He received a certificate in physical therapy from that institution in conjunction with UCLA Hospitals and Clinics. Weinper later received his Master of Public Health degree (M.P.H.) from UCLA in Health Services Administration and his Doctorate in Physical Therapy from the EIM Institute for Health Professions in Louisville, KY. Weinper has been active in the American Physical Therapy Association (APTA). He has served as a member of the APTA's Task Force on Physician Ownership of Physical Therapy Services, as a member of its Committee on Physical Therapy Practice, as the association's chairperson on its Task Force on Reimbursement, on the Board of Directors for APTA's California Chapter and national Private Practice Section, and as trustee of the APTA Congressional Action Committee (now known as PT-PAC). Weinper received the prestigious Robert G. Dicus Award from the Private Practice Section of the APTA in 2000, and he received the Charles Harker Policy Maker Award from the APTA Health Policy and Administration Section in 2011. On behalf of the state of California, Weinper has served as a member of the Physical Therapy Subcommittee of the Division of Industrial Accidents, now known as the Division of Workers' Compensation. He also has served as an expert to the Medical Board of California, where among his activities he has appeared on behalf of the People in insurance fraud trials. He has provided expert witness testimony on behalf of more than 20 insurance companies. A former associate professor of health science at California State University, Northridge, Weinper is a frequent presenter for various professional associations including the National Managed Healthcare Conference, the American Medical Care and Review Association, and the APTA. He has authored many articles for both physical therapy and insurance industry publications. For more information on Stephanie: Dr. Stephanie Weyrauch is employed as a physical therapist at Physical Therapy and Sports Medicine Centers in Orange, Connecticut. She received her Doctorate in Physical Therapy and Master of Science in Clinical Investigation from Washington University in St. Louis. Dr. Weyrauch has served as a consultant for a multi-billion dollar company to develop a workplace injury prevention program, which resulted in improved health outcomes, OSHA recordables, and decreased healthcare costs for the company's workforce. She has served on multiple national task forces for the American Physical Therapy Association (APTA) and actively lobbies for healthcare policy issues at the local, state, and national levels of government. Currently, she serves as Vice President of the American Physical Therapy Association Connecticut Chapter and is a member of the American Congress for Rehabilitation Medicine. Dr. Weyrauch is also the co-host for The Healthcare Education Transformation Podcast, which focuses on innovations in healthcare education and delivery. Dr. Weyrauch has performed scientific research through grants from the National Institutes of Health and National Science Foundation at world-renowned institutions including Stanford University and Washington University in St. Louis. Her research examining movement patterns and outcomes in people with and without low back pain has led to numerous local, regional, and national presentations and a peer-reviewed publication in Archives of Physical Medicine and Rehabilitation, a top journal in rehabilitation. Read the full transcript below: Stephanie Weyrauch (00:00:01): Hello everyone. And welcome to the healthy, wealthy and smart podcast. I'm your guest host Stephanie Weyrauch and I am interviewing Mike Weinper who's the president and CEO of physical therapy provider network or PTPN as it's better known and also a private practice owner for progressive physical therapy in California. The reason that I wanted to talk to Mike today, as he won the Robert G Dicus award for the private practice section back in 2000, and he has been an instrumental person in practice, leadership, innovation, legislative, and political issues, healthcare reform, and a number of other areas where he's really had the opportunity to champion innovation and leadership. And one of the things that, you know, we know it's 2020, and obviously vision 2020 has something that has happened in the APTA was written back in 2000 and in Mike's Dicus award speech, he talked a little bit about where he thought the profession would be in 2020, in 2000. And so I'm really interested in kind of his take on where we are today. So Mike, welcome to the healthy, wealthy and smart podcast. And tell us a little bit about yourself. Michael Weinper (00:01:21): Well, thanks Stephanie, for the very nice introduction and it's a pleasure and an honor to be with you today. At some level, I'm considered by some, to be a dinosaur, having gotten my Dicus ward 20 years ago, and now long in my career, I'm just celebrating my 50th anniversary as a PT. So I hope that some people won't tune out just because of that. Maybe if nothing else, they can see me as a history lesson, any event, I can tell you that back in 1992 the California chapter of APTA now called California PT association created a long range planning task force that I was honored to serve on. And in that task force where a lot of leaders in the profession in California names that were household names, then probably names and most people would not know now, but our plan was to draft a long range vision. Michael Weinper (00:02:21): If you will, a crystal ball of what things would look like some 18 years later in 2010, kind of looking back, it's interesting to look at and we created, I believe 18 different points that would be goals if you will, of the association and the primary aspects of that working document, which was called PT 2010 by the California association. I'm sure if you were interested, you could look it up or get a copy of it. Then later became the working document for APTA called PT 2020. And since we are now in 2020, I wish we would have known then what we know now, because things have dramatically changed in many ways, but in other ways they have not. And so I guess I could give you some of the ideas we envisioned back in 1992, if you'd like, and then we can take it from there. Michael Weinper (00:03:23): So in that document, we said that PTs would be able to evaluate and diagnose conditions that's true today, perform specialized treatment procedures and work in teams with physical therapists and PT assistants. So all that did come true. Next, the PTs would be able to initiate services subsequent to their own evaluation diagnosis without referral from or diagnosis by another practitioner. And that in 2000 that had not yet been accomplished, but we, now we know we have independence and practice almost every state with regard to our licensure. In most therapists are, would be in independent press configurations with other therapists, maybe who would work in a hospital. In other words, there would be an opportunity to be clinically specialized in it with a board certification, which we now know has really grown quite a bit. Michael Weinper (00:04:25): And they would be sought out. These specialists would be sought out by consuming public and third party payers. Not as much. I don't think our profession has reached to the public well enough to get the public, to understand what a board certification really means and what it takes to become a board certified specialist in our profession, but I'm progressing for a moment. Anyway. So then we said that PTs would be able to be involved in the continuum of care from the hospital to the home, to the private practice. In other words, PTs would have hospital-based privileges and they would be able to go there. And then if the patient were home, many of them would be able to then go to the patient's home and treat them there and then follow them up in the office. And so that was another kind of idea we had way back then. Michael Weinper (00:05:21): So it would be basically following the patient through the episode of care from beginning to discharge and obviously getting them ambulatory and functional. We also said that this is a good one that PTs would become diagnosticians. And more importantly that we would be at the entry point in healthcare which wasn't the case in 2000, but in now in some places, it is that therapists are in fact these musculoskeletal specialists would be a cause we can do it musculoskeletal evaluation or diagnosis many states now recognize that. And some insurance companies have recognized that we can be an entry point into the system, which I believe going forward, it's going to become much more prominent because of the higher cost of care. And actually Stephanie, the difficulty we all experienced when we try to refer a patient to a specialist, state, an orthopedist or a neurologist to do an evaluation so we can follow the patient. Michael Weinper (00:06:18): We find that it can take several weeks for that patient to get in, to see the physician, whereas they can usually get in to see us in a few days. So I think that's something that we will see more of in the future, but back then we had it as a dream, but not a reality. We also said that at that time, that instead of 24 weeks of internship that were experienced by PT graduates back in those years, we thought internships would last one year. Now that I don't think there's a, but we have in fact seen fellowships and other levels of work where therapists are really going into specialization so that they in fact can do things over a year's period of time and then becoming sort of like specialists. So those were sort of the, kind of, I think the basic things that would be of importance today. Michael Weinper (00:07:15): We did also, this was a very important one. We identified that in the year 2010 PT would be a doctorate profession. That was what our key points of doctorate and profession. And lo and behold now our entry level is what a DPT, a doctorate. I'm very proud to say that I went back and got my DPT a little over 10 years ago. I talked back in 1982, and I certainly wanted to walk the walk before 2010. So cause that was our benchmark was 2010. So with that in mind I think it's important to realize that we have become doctoral people. In other words, we are now at a level of sophistication with our education and hopefully some research that gives the PT of today a much broader view of a patient, their wellness or their disability, and gives them better tools, which the function do the evaluation or assessment of the patient, and then follow up with treatment compared to how things were back when I graduated in 1969. Michael Weinper (00:08:31): So and I found that when I got my DPT that I learned quite a bit. I learned some of the things I learned actually were more on how to think differently than I had thought previously. And I will tell you that some of the things that I learned that were most valuable to me was how other people think so studying with other transitional DPT candidates gave me an opportunity for me because I was the oldest person in my class. Gave me an opportunity to hear people think and how they process, how they analyze and how they come to the decisions they do. And then how do they communicate it? I like to think I'm a good communicator, but oftentimes I get really wrapped up or wound up and, you know, I go off on a tangent and I probably go down the rabbit hole and maybe other people in today's world are much more succinct. Michael Weinper (00:09:31): And to the point also I can tell you that I was privileged back in 1975 to get my MPH at UCLA and the school of public health there. And I learned a lot about things that are important today, including epidemiology, which we now know is at the forefront of everybody's thinking and infection control and making for safe environments, which was only very basically touched in my DPT program. But one of the things that I really enjoyed was the differential diagnosis courses I took and the radiological courses I took that gave me a much broader sense for things that I'd studied back previously, or maybe taken some content courses, but went into much more depth and listening to other people discuss those kinds of things. So that's how things were back then. I can tell you also that insurance companies were perceived to be able to give PTs a lot more latitude. And it's only been in recent years that many insurance coverage industry to pay for PT. That's independent of physician referral. We're still working with Medicare on that. You and I know all the snow and I think the day will come that the feds will start to get a little wiser and realize the cost benefit of the PT being an entry point into the system. Stephanie Weyrauch (00:10:58): I think that that's a really great overview of kind of what you guys envisioned back in the early nineties and kind of correlating that with vision 2020. So the APTA vision 2020 and a couple elements that made that basically encompassed a lot of what you said. So autonomous physical therapist practice was one of them, direct access, evidence based practice, doctor physical therapy and lifelong education PPS as practitioners of choice and professionalism. So those were when the house of delegates discussed this, those were the main themes that they were looking for. So keeping those themes in mind, let's maybe start by talking about the doctorate of physical therapy. I mean, that was something that you were obviously very proud of. You will talk the talk, you walk the walk. So what do you think? Well, studies have been shown the DPT student debt now varies between 85,000 and 150,000. Okay. Do you think based off of what we're seeing today, as far as student debt, do you think that today's DPT is a good return on investment? And do you think that the salary for the physical therapist has kept up with the increases in training and inflation? Michael Weinper (00:12:14): Well, I'm very happy to hear you raised this question because it's a question that I not only think about a lot. I talked about a lot with my colleagues and I also talked with students who are becoming PTs and people have gone into residencies for a year post-doctoral now for purposes of gaining a better outlook on things. And I must tell you that when we gave thought to the idea of PT being a doctoral profession, never in our wildest dreams, did we think about the cost benefit aspects of it as it relates to educational costs back then costs were not inexpensive. You should teach part time at USC and Cal state university Northridge. And I remember students used to complain about the cost of education back then, but it was nothing as compared to today. So to get to your point, I am sad to say that we have not grown our income levels for PT to the level that they should be given the doctoral training that we received. Michael Weinper (00:13:29): And the depth that usually goes with that, unless you've got some kind of a rich uncle or a greatness scholarship, having said that most PTs coming out with a lot of debt, and then they find themselves in jobs that they don't want to do. Let me just elaborate a little bit on that. PTs in private practice is considered by many to be the desired venue in which to work because patients are coming to you. You have all kinds of equipment and resources and hopefully a nice facility to work in. And the patients for all intents and purposes are ambulatory or said differently. You're not going to be ambulating a patient in a hospital hallway and have something happen to your shoe. If you can get my drift in any event, it seems that most PTs that come out of school today are struggling with where they want to work versus where they have to work and where they have to often work or those places that pay more because they're less desirable. Michael Weinper (00:14:35): So as the desirability quotient increases, the unfortunately the salary decreases because of in part supply and demand. And also to a greater extent because insurance companies are not reimbursing PTs in private setting, like they are in the hospital, for example. So if I go to work in the hospital, I can make a lot more right out of school than if I go to work for an independent therapist in the same community. On the same side, I can go to work for a home health agency, not have this desirable of a work environment. Have you seen changes from patient to patient, but make better money, but then again, have other costs of doing business. And I think at the end of the day, those who do home health, and I don't mean to criticize those of you who do, but if you look at your cost of doing business and take that away from your income, you find that your true income is much less than you thought it was going to be. Michael Weinper (00:15:30): Whether it's wear and tear on your car, gasoline insurance, you have to carry on your own, whatever it may be, equipment you might have to buy and so on. So it seems to me that the desirability of where you'd like to work and the pay ratio is a universally, but proportionate with that in mind, it's a function of insurance companies, and this is where I really go down a rabbit hole. And that is why are PTs and private practice paid less? And the answer is because PTs in private practice accept less, they have an, I am very secure, experienced on this. Having started PTPN 35 years ago, a managed care company for PTs in private practice. And we have always advocated for higher reimbursement. And in fact, we Protestant have been successful in getting a higher reimbursement for PT and practices that are in our organization. Michael Weinper (00:16:30): Then PTs were in the community who are not in our organization. However, because PTs are willing to accept whatever insurance company pays. In other words, they don't want to lose business. They accept fees. They're much lower than they should. And that has driven down the value of PT in the mind of the insurer and that's led to lower salaries. And so to get to the end of this thought, PTs coming out of school, don't get proportion of the kind of income they should with a doctorate. And let's contrast that for just a moment to a PA, a PA has less training than we do. They will usually get a master's degree. They work in a physician's office, but the way that they can bill under the physician's license gives them much better reimbursement. It makes them more valuable to the physician and therefore their income is oftentimes much greater even out of school, you know, apples to apples. Then we get as a PT out of school. Stephanie Weyrauch (00:17:31): Yeah. I think you make a lot of really great points there. I mean, the doctor, the DPT was obviously great as far as, you know, gaining direct access, being more autonomous, but you know, the cost of education has obviously sky rocketing it. So based on, you know, your ideas, what do you think that the private practice section can do to help guide new graduates through the uncertainties of student debt? Michael Weinper (00:17:57): Wow. there's a lot of things that come to mind. First of all, we, as a profession have to be better educated to know when to say, no, that's a K N O W and N O in the same sentence. Know when to say no. In other words, if insurance companies are offering rates that are below what it costs us to business or below what we think we should be reimbursed, we need to learn to say no to them and walk away from that business. Maybe it's better to see fewer patients and make more money and be able to compensate our staff better than to take every insurance contract that comes down the road that pays less than it costs you to run your business. Those in private practice who might be listening to this podcast are shaking their heads affirmatively I'm sure because they get it. Michael Weinper (00:18:47): Those who are not in private practice probably don't understand what I just said. I don't need that it was criticism, but I think that at the educational level, during your basic education it's therapists need to learn more about socioeconomics as it relates to our profession. Supply demand economics certainly, and cost of doing business are key points. In years past for APTA taught courses on economics made easy for PTs because many of us come out of school even today without very much in the way of business knowledge or knowing much about economics. And once you learn more about that, things become much clearer and it makes it easier to make decisions that are in the best interest of our profession. So I think the PPS can, it does from time to time try its best to educate us on how to be better managers, if you will. Michael Weinper (00:19:51): And that includes things like the economics. But I think we, as a profession need to be top of mind with economics and learn how to advocate more as a group, as a profession, not just individuals because insurance companies will not look, listen to individuals. They will disappear to larger groups. To that point, larger groups get better reimbursement. So that point hospitals being really affiliated with one another or powerful entity as an association get better reimbursement. So I think that getting PTs together to understand I know APTA has advocated for many years better reimbursement. I worked with APTA in different retreats for payers. So there was a way to bring together a summit, a payer summit, they call it where they bring together many insurance companies. Actually I did one in Connecticut where you are cause that's a sort of a hodgepodge or location of many insurance companies. Michael Weinper (00:20:55): So we had several speakers who knew a lot about reimbursement, including Helene furan, a dear friend of mine and others who would speak to insurers about what is PT? What does a PT do? How do we evaluate patients? What does it cost to run a business to give these payers a better understanding, but remind you be reminded. These were not big association meetings. We brought peers together. So we might have 25 or 30 people in a room, some of whom which were larger decision makers than others, but when it came right down to it, we didn't have the ability to follow up with them and push them down the road to where they would be accepting of what we do. So we today, the cost benefit of coming to PT, I'm sad to say is very disappointing. It takes you a long time to work off your debt. Hopefully in the future, our government will see fit that people in professions like ours need to have better forgiveness of their debt in return for doing public service for the public we serve. Stephanie Weyrauch (00:22:06): Yeah. I think that you make a great point about the fact that we as private practitioners need to walk away from some of these more measly reimbursement contracts. And you know, one of the things that we hear a lot with incoming graduates is that there are a lot of private practices that have very high volume. And one of the reasons that they have low job satisfaction is because they're seeing so many patients. So I think that you make a really great point in saying that, you know, maybe it's better that we take fewer insurance companies, see fewer patients, but get paid more because now you're eliminating that burnout and that poor job satisfaction and allowing that new professional, or, you know, even if it's a veteran physical therapist, make the money that they actually deserve with the training that they have. Michael Weinper (00:22:58): Exactly right. And that's why we need to really advocate politically. And that's why the PT PAC is a very important thing to be involved with because we, as a profession can be heard through advocacy many, many years ago, I was one of the early trustees of what we used to call APTCAC American physical therapy, congressional action committee, which now PTPAC. And I always used to say, and I consider you to say today, if every PT would just give $25 to political action, how much more strength we could have because we live in a world where legislators listen to those who support them, support them with votes and support them financially so they can get folks important that we do get to legislators. Michael Weinper (00:23:54): We have a lot of people in Congress who are friends and have been our friends for many years, but we need more. And when things come up like budgetary cuts of Medicare, where they talk about an 8% reduction in Medicare reimbursement coming in next January, which I hope goes away. I think it will go away. I pray it would go away. But if it doesn't, I mean, think about that. You're getting a reduction in your reimbursement, which is not that great today. And they're going to reduce it even more. What's that gonna do to salaries? It's not going to help the PTs in private practice. And this is something that I think many people who are not in private practice, the students podcast may or may not, may not believe, but it has to be true. Michael Weinper (00:24:40): I've spoken to hundreds of PTs in private practice over the years. And I think many people would be appalled or shocked at least to realize that many people who own private practices do not make a lot of money. I spoke to a PT just last week here in Southern California, who was impacted by the rallies that were going on with black lives matter. And unfortunately, during that time, there was some looting and pillage went on by some bad actors, if you will, not people who were affiliated with the rallies themselves, but people who took advantage of that and broke into places and solving fuel and burn places. We all heard about that here in Southern California was one of those places in other parts of the country, the same thing that held true, that PT, when I talked to them and was trying to do what I could do to help them rebuild their practice. Cause your practice had been broken into and everything taken. Michael Weinper (00:25:42): I asked this individual if they would be willing to share with me how much they make per year. This person said to me, under $80,000 Michael Weinper (00:25:58): And I pause for a second. And since not only for the problems they were experiencing because of the looting and stuffed up to their office, but for the fact that even under good times, they weren't making a lot of money and they were working hard. They're working 10, 12 hours a day, sometimes on weekends. That is because they were in a situation where their cost of doing business is almost as high as what they would receive in payment. Michael Weinper (00:26:24): And we know that owners of businesses get what's ever left over after paying all the other bills, including salaries and benefits and rent and all the other things that come to mind. And it's not uncommon to find people who own their own practices, who do not make a lot of money and you have to take a lot of risks. So it's one of these things that we need Congress to better understand that it's important to support physical therapy as a profession, because we are a very valid and important aspect of the health care continuum that if we aren't there the cost of care will go up because rehabilitation, I believe, and I'm sure you believe decreases overall cost of care. So getting Congress to vote that in and to budget more money for us and Medicare, and then hopefully getting insurance companies to understand that not every therapist is going to do things on the low ball side of it, but really are going to hold out for a higher compensation that they're entitled to. Michael Weinper (00:27:36): They're going to be more inclined more and as a parent more it's my idea that therapists should be able to own practices to be able to pay their staff more. I've always said, Stephanie, that I wish I could pay every therapist that works in our practice, $150,000. I think they're easily worth it, but it's a function of what we get paid. And I can tell you that, you know, my own practice, progressive PT my income hasn't gone up in over 10 years and I don't make, you know, I don't make a lot of money in it, but it's because I get what's left over after we pay everybody. I feel that we've got to give our employees reasonable compensation for what they do. And we don't use a lot of extenders. We don't do a lot of things that are in the realm of I'm doing it on the cheap side as many people do. Stephanie Weyrauch (00:28:31): Yeah. I think that your points about advocacy are really important because I know APTA has been working on that 8% cut. You haven't written to your Congressman. I definitely encourage those of you listening to this podcast today to log onto APTA's website, whether you're a member or not and write a letter to your Congressman, it really only takes three seconds. Additionally, there has also been a legislation that has gone forward with trying to increase the loan forgiveness for DPT students. APTA is always trying to get us to have pay, be paid more so that advocacy piece is really important. So that kind of brings me into the next pillar or the next element of vision 2020 and that's full direct access. So we do have at the some form of direct access in all 50 States right now, however, there are three States where the direct access is extremely limited, where you basically can only do a wellness evaluation without a doctor's referral. And then there are about 27 States where you have direct access with basically limitations or rules attached to it. And a lot of those have to do with say diagnosis or with different interventions like dry needling or electrical stimulation. Those types of things. So kind of along that route, how can PPS ensure that we get full direct access in each state? What are some things that the association can do and that physical therapists can do? Michael Weinper (00:30:04): That's a wonderful question. And I think the answer is create stronger advocates in each state because what you're talking now is not about federal legislation, but state legislation. In other words, each licensing act is governed by the state legislature. So having a good group of PTs who can rally and lobby, if you will, or have a lobbyist, if there is a big enough state to meet with members of the state legislature to express how important it is in an effort to control costs in healthcare, to give therapists more clinical rights and abilities, that's where it starts. Once you get that, then you can get insurance companies to start to buy in because they realize that is legal in that given state. I have seen this happen throughout my career that has been slow to come. We've been shooting for direct access. And at the same time also trying to eliminate the need for there to be physician intervention in certain musculoskeletal situations where we now are trained as diagnosticians to be able to evaluate and treat these things. Michael Weinper (00:31:17): It's my hope in the future that we get the opportunity from a licensure standpoint to order x-rays, to order lab work and things like that, to where we can have more information at our fingertips, but then to have to refer out. But only where it's appropriate, where we're adequately trained to do that. You have to teach legislators what is PT and what is the benefits of PT and what are the cost savings that insurance companies, the public. And we all save by giving the opportunity for patients to be strong entry points into the healthcare field. It's certainly fond for us to evaluate patient. And in some States you can do, like you said, dry needling. I live in a state, California doesn't even allow dry needling. I have people in my practice who teach dry needling to therapists around the company because he used to do that where they worked in other States, very frustrating for them, extremely frustrating for me, but it takes legislation. Michael Weinper (00:32:25): It takes talks. It takes contributions to your local state PAC, and most of them have it now. And to be involved in APTA, I think is key that so many PTs I call nine to fivers. They come in and they do their nine to five and go home and they forget about their profession. People like you and others who are dedicated to making this a better profession for PTs of the future, not to mention the public that receives our care are the ones that make things happen. And so being more involved in our field through volunteerism obviously is key, I think, to change and too many of us look to the other guy to do it, whether it's writing a letter to your congressmen, or there's going to meeting with a state legislator, whether it's inviting your local state representatives into your practices, see who you are and what you do. Michael Weinper (00:33:27): All of the things bode well for growing our practice. And too few of us, unfortunately do that. We don't realize that it starts fortunately with regulations and what we can do and how we can do it. So the quest, if you will, or request, I should say would be that we as a profession, get more involved in our association because the association is the focal point for getting the information to legislators. It's our association that has the greatest credibility. And I can tell you that one of the reasons I went back and got my DPT was that I saw that when I would testify on a bill in Sacramento here, there would be people with a doctorate, not necessarily in our field, but just doctorates, so would speak against what we were doing it. And I would get up there and I would have 40 years of experience, and we have a master of public health degree then on my doctorate. Michael Weinper (00:34:26): And I were always, and I would like to think I had good presentation and good preparation and knew the facts. And yet it was those who had doctorates that were, or had the title doctor who were paid more attention to now, we as PTs have that title. And now we're sort of in a level playing field with other professions, from the term being entitled a doctor. And with that credibility, we need now to take more action, we need to spend more time trying to create change in my Dicus talk back in 2000, I said that people were afraid of change and it's true. And even today they're afraid of change and we all like the status quo, but the reality is we need as a profession to embrace change because with change comes progress and we need to progress as a field of profession. If you think about things it takes a village if say and certainly in our professional, it's no different, we have to be part of that village. We can't just be part of the tribe. We need to be active leaders of our village. Stephanie Weyrauch (00:35:43): Yeah. And I think, you know, if you look back at where we were with direct access 20 years ago, I mean, obviously we're in a much better state than where we were, but some of the resources that I know PPS has for people with their fighting, the direct access is they do offer grants to state associations if they're doing any type of lobbying. So if you haven't applied to one of those, it's a pretty hefty amount of money. It's like five or $10,000, which that goes a long way when you're paying the lobbyists to do the work for you. You know, they also have a key contacts program and they offer resources for practitioners that if you do invite a legislature in a legislator into your practice, or you are trying to advocate for a bill, like they provide all that information for you on their website and on the APTA action app. Stephanie Weyrauch (00:36:29): So, I mean, PPS does have resources out there that we can utilize to try to continue in our fight with direct access. And I mean, yes, we're in a much better place than where we were 20 years ago, but like you said, change takes time. And as a, you know, as a young professional, I definitely would love to see change happen even faster. So you know, the more people we can get together and build that village, the faster it's going to happen in your Dicus speech, you also talked about how you envisioned that physical therapist will be evaluating and diagnosing conditions, performing specialized treatment procedures and working with the PTA team. And then you also envision that there would be no referral needed by another practitioner. And I know you've kind of covered this a little bit, but give us an idea of where we are, where we're at with this prediction and what you think the future holds. Because as you know, a lot of these direct access bills that we have still restrict our ability to quote unquote diagnose conditions or even perform specific procedures. So kind of give us an idea of where we are compared to 2000 and where you see us going in the future. Michael Weinper (00:37:41): Well we are obviously light years ahead of where we were in 2000, just by hearing what you described to helping things in what I predicted. And I think from the standpoint of going forward, we need to be cognizant of the fact that we can change things if we put some effort to, and in other words, so many therapists don't do things because I think I hear people say, Oh, it doesn't make a difference, or they'll say somebody else will do it. And the truth is that we all need to be more involved. And I'm one of those key contacts and have been for many, many years. I can only tell you that how rewarding it is to invite a legislator or even somebody who works in their office, into your office, into your practice, to visit with you, see what you do, talk to you, the things that are your barriers to growth and barriers to doing for patients, what we should be doing and should have been doing for many years. Michael Weinper (00:38:46): And I think it's more important to understand what you can't do versus what you can do. And you only learn that by going to stage or talking to people in other States who have full privileges to do those things and have that true autonomy. So I think that by attending association meetings, for example, PPS is a great example or CSM when it comes back. And, and I say this, not just going to the meetings, but talking to people, not just your friends, but talking to people you don't know, but from other States where you might know there's a lot more progress, ask them what they did and how they did it, or talk to the leadership in those States, in those state associations and ask them, how did they accomplish what they accomplished? Because it takes a lot of work and there's a lot of resistance by other professions, physicians be it chiropractors, osteopaths, even dentists from time to time resist, having us grow to where we should grow. Michael Weinper (00:39:53): And the key again is educating the public, what we do. So when you're treating them, let them know what you can do, what you can't do all because of the laws, even though you might be trained to do these things. And sometimes the best advocacy doesn't come from ourselves. It comes from the people we serve our patients. So getting people to write letters to their members of the legislature is very important. But I think getting more people to stand up, write letters, attend hearings in your state Capitol become more involved, become more aware of the benefits you can create, not only for the professional, but certainly for yourselves as well. And that's one of the reasons that I've been very involved in APTA throughout my career was I felt that I had the ability to change things if I would only work at it. Michael Weinper (00:40:47): And I was very blessed. You haven't brought it up, but Bob Dicus for who the Dicus award is named obviously was one of my mentors. When I was a student, I got to meet Bob. He was already very deep in his ALS disease in Georgia. He was fully wheelchair bound and tied to a respirator, but that man had so much knowledge. He was one of the first private practitioners. And one should only go to the PPS website and learn more about Bob and what a great man he was and what a visionary he was for our profession. As a matter of fact, just to digress for a moment, he is the one who created the ALS society nationally. He was the inventor of that. He had a second professional. He was in, he was a motion picture producer in his later years when he couldn't be a PT, he went into motion pictures. Michael Weinper (00:41:48): A lot of them had to do with rehabilitation and things that we do. They weren't necessarily featured like Sims, but he got involved in that kind of communication. So it always goes to the fact that I think some of the best PTs are the ones who are best able to communicate with their patients, with the public, with our legislator. Sure. Those are the PTs who really do the best, because if you're good with your patients in communicating, you're able to motivate them to do the right thing. Right. And communication is something that we need to study more perhaps in school. I teach a lecture on communicating with different generations because as I become part of the older generation and looking at the younger people, I see how you and others in your generation and younger generations communicate with one another as much different than what my experience is. Michael Weinper (00:42:43): I grew up with our computers. I remember the very first calculators. We were not what I was going through school in high school. We used an Abacus and a slide rule. And then going forward, we used a Texas instruments brand calculator, which was very expensive and very elementary looking back at it. That's an idea of technology when technology and communication are, I think are very interwoven. In other words, as technology increases, communication becomes dependent on that technology. And we tend to communicate less with one another or said differently. I can see my son-in-law and daughter at our house, sit on the couch, waiting for dinner, remake, and what are they doing? They're texting. And I said, who are you texting to talk to them? Wait, what answer? Just speaking with one another. And that's just the world we live in. And then all the little acronyms, all these simple things that you know are, are part of the lexicon today. Michael Weinper (00:43:56): Today's younger people, older people don't necessarily know. And when treating an older patient, it's key that you speak to them in a communication form that they're going to understand. And don't assume they understand. I mean, you're saying just because you're saying it, and the same is true for older therapists like myself, talking to younger people, you have to motivate them in a different way. Young people want it. Now they want things quickly. They're used to getting information quickly. You go with something up on Google and get an instant answer on something. Whereas back in my day an encyclopedia sales person used to knock on our door, trying to sell my family a big set of 30 books of encyclopedia. We were tell much to us what we needed for today's knowledge. And I don't think those people around anymore. If at all. If you wanted an encyclopedia, you've got it. Michael Weinper (00:44:50): Just look up something in Google or another search engine, and you've got instant. You got too many answers. Sometimes you get different answers for the same question, but with all that in mind, communication is key to success. And we as service need to communicate better, not only with our patients with one another, with our legislators and with the public in general, and to that point, having better PR public wise. And I think APTA is trying to do that. Now that we're into our hundredth year, starting there as your celebration or Centennial celebration. I think you're going to see a lot more information going out to the public, through electronic media and social media, to where we gain a higher visibility with the public. Michael Weinper (00:45:38): I had the TV on the other night, I was watching a game show and one of the contestants was a PT. And he was a young PTA until that. And he didn't want a whole bunch of them. I think it was, I believe the show was a wheel of fortune actually, which I don't watch too often, but it was on. And I've heard the word physical therapist. It's just like you, whatever you heard that word somewhere. Even as sitting in a restaurant, you hear somebody talking about their PT, your ears perk up and you sort of start to eavesdrop a bit. And we as a profession don't hear that word in the public as much as we hear about doctors or other things. So I think the public needs a better awareness of who we are and feel comfortable talking to us. And we need to feel comfortable talking to them and educating more about who we are for. They haven't needed to see us. Stephanie Weyrauch (00:46:26): I think you make some really good points about the communication aspect and that kind of leads into the next element of vision 2020, which is us being practitioners of choice. So in kind of going off of that with communication, it's too bad Bob Dicus, isn't around anymore to make the next hit healthcare drama on physical therapists. I mean, how many physical therapists and healthcare dramas do you see walking patients or stretching patients? You know, it's never really, they're never main characters in, you know, like Chicago med or Grey's, you know. Michael Weinper (00:47:05): Anytime I see a PT portrayed in these situations. I cringe because first of all, they're wearing, and I hate to say this cause I'm going to probably, I'm going to take an issue with some of you they're wearing scrubs. I don't think I don't scrubs when I grew up were for people working in surgery. Now everybody wears scrubs. So you go to the grocery store. People were in scrubs. They, I think people not even in healthcare wear scrubs sometimes, but I think we should look more professional. We should be more professional and the public will respect us better if we act more professional. And so there are some times PTs who are brought in on dramas to be a technical advisor. I have been in that position before twice, and I have talked to directors and producers about what they need to show. Michael Weinper (00:48:05): And I can only tell you that what you tell them to do and what they end up doing sometimes is different because maybe they don't have the right equipment or the character. They thought they already lined up costumes for their characters. It becomes very frustrating, but getting in on the front end and getting the public to understand who we are, hopefully through drama and maybe through, you know, like I say, public service announcements or ads on TV where we're portrayed better or having the opportunity. Many of you are in smaller cities and towns, your local newspapers and television are hungry for local news. And you may be doing something you don't need to think second thought about, but it's newsworthy. Maybe you just purchased a very important piece of equipment to help with ambulation or suspension or something technical electronically to create new opportunities to treat patients your local TV stations would love to demonstrate, come to your clinic, film you doing that and have it as a segment on their TV show. Michael Weinper (00:49:21): And many of us don't even think about that. So and I, again, even in Los Angeles market, I've had the opportunity to do that a couple of times. And it can be a little bit overwhelming, a little bit scary, but you know, something at the end of the day, you feel really good about it and how you come across is much better than you perceived. You are going to come across when you're getting ready to do it. So don't be shy, but reach out to your local media and try to get them interested in what you do, because what you do, what I do is very newsworthy and very important for the public. Stephanie Weyrauch (00:49:52): Yeah. And you know, obviously people are following what the media says and listening to the media. So, I mean, the media is, has been a very powerful force that you can utilize to spread the gospel of physical therapy so that we can become the providers, the practitioners of choice, for the musculoskeletal system. And so the people actually know that PT means physical therapist and not like personal trainer or part time, people actually know what it means in your speech. You also stated that PTs would be recognized by payers as diagnosticians an entry point into the healthcare system. And I know you've talked, you you've touched on this a little bit, but how do payers recognize physical therapists and how do today's payers recognize us compared to back in 2000? Where are we at with that? Michael Weinper (00:50:43): Well, back in 2000, and even in day sense, payers felt we needed to be treating only under a physician's referral. If you looked at insurance policies that you might have, or if you spoke with payers, they would say that PT was a covered service when provided or the auspices of a physician referral or diagnosis today. Many of those policies from the same payers do not have that language. So because of the direct access laws and because of therapists and given States talking to their insurance companies, the payers they've educated them to where certain payers are starting to realize the benefits of PT first. And let's just take substance abuse and chronic pain. We know as musculoskeletal experts, there are lots of things that we can do for the patient to avoid surgery, to avoid downstream costs like expensive imaging that may be unnecessary. We can certainly get the patients treated properly and get them in a mindset to where pain is not top of their mind. I have a book sitting right behind me on my bookshelf. It's called explain pain. Are you familiar with this book? Stephanie Weyrauch (00:52:13): Oh yeah, that's a very familiar book. Michael Weinper (00:52:16): Okay. And this was a very good book for people to read. It's the authors are David Butler and Lorimer Moseley, and they're down in Australia, but they talk about dealing with the mental side of pain, the cognitive side of pain, if you will, and how to best creature patients in deemphasize of pain and emphasize wellness or health. And we need to do more of that as practitioners. And as we can educate our insurance companies, that by sending the patient to PT for four or five, six visits, we can avoid surgery, many cases, what is a cost benefit to the insurance company? Their insurance companies listen to money. And I know this from my experience for many years of working with many of them speak with probably too many insurance companies to not only remember, but to count. And they are driven by dollars and they do not put enough emphasis on times in their underwriting to allow PTs to do the things we do. Stephanie Weyrauch (00:53:26): Yeah. Michael Weinper (00:53:28): Shortsighted because they ended up then forcing patients to go to a physician first, wait, several days or weeks to see the physician where the patients only getting more deconditioned. And rather than just seeing us first, and we have the opportunity and the knowledge on doing things that get the patient out of the problem or fixing the problem, if you will, from a nonsurgical standpoint. So insurance companies in some cases have become much more enlightened and other cases are still in the dark ages. And those who allow us to treat without referral and pay us for what we're worth are the more enlightened ones, some insurance companies that I've dealt with now in recent years are paying for outcomes. There's concept of paper for pay for performance or P for P. I like to call P fro. It's really not what you do, the process of what you do, but really the outcome that you get. Michael Weinper (00:54:27): So if you can get a great outcome with fewer visits, then insurance company should be willing to pay you more because you reduce their costs. And, not only of what you did in terms of your crew cough, but in terms of what would otherwise cost them to treat the patient going forward. So I like to pay to pay for outcomes Peterborough, and that's why we, as a profession, need to do more in the way of outcome measurement, whatever tool we use and be able to communicate to the payment payer community, the benefits of what I do. So I'm going to go back now to the mid seventies again, when I got my master's degree we learned even back then that the definition of quality in healthcare was composed of three things. And the author of that was a fellow who's no longer with us. Michael Weinper (00:55:22): His name was Avitas Donabedin. He was a physician. He was very involved with the new England journal of medicine, D O N A B E D I N, if you want to look it up and Donabedinn even back then said that quality health healthcare was three things structure, which is where you do it and what you use in terms of equipment process, what you do okay. And outcome, or the results. So we all have been able to measure it structure, and we were able to mission measure the process where you, but not enough of us over my career have been able to truly prove that what they did was a benefit. And I think that that's one of those things that we have to focus more on proving the benefit of PT two outcomes or said differently because of what we do, patients get better quicker. Stephanie Weyrauch (00:56:16): And that leads us really nicely into the next element of vision 2020, and that's evidence based practice. So obviously APTA has done a lot over the years to try to improve how we're measuring outcomes. So you have the outcomes registry CoStar was created. If you look at how much the literature has been put out for, if you search, if you search up physical therapy, even in Google, it's, you know, an exponential growth since even 2000 and even the larger growth. If you think about it from even the 1970s, when outcomes were first described. So, I mean, this is something that, you know, we've been working on for a long time. I think that obviously it's come a long ways, but we still have confirmation bias in our literature. We still have group practice that people are practicing. We have treatment fads that really don't have a lot of evidence behind them. And we have practice variation that continues to affect our outcomes and affect our profession. How can PPS help offset this? How can we continue to go forward to mitigate some of these things that are occurring? Michael Weinper (00:57:24): Well, that's a $64 question, as we used to say my hero. I think it's important that we need to, you talked earlier about one of the goals of PT, 2020 is lifelong learning. And I see too many people in our profession who don't come to meetings of the profession, whether it's a local meeting in your area, whether it's a state conference whether it's CSM or PPS meetings, too many of our colleagues never go, or maybe they went as a student cause their school paid for them or somehow or another they're were to go. And they never ever go. If you think about people, you went to school with Stephanie, you never see them again. And you wonder, how are they getting their education? One of the things that has occurred a dream the last 15 years I would say is the requirement by States that each PT in order to continue, their licensure must have continuing education, a certain amount. Michael Weinper (00:58:35): And it varies state by state, as we know, and what things have to be parts of that, continuing education, again, vary by state by state, but at least we're being forced now as a profession to continue our learning. Having said that, and having taught in different venues in different ways. I can tell you, there are people who are serious learners, and there are people who we call lazy learners. The lazy learners are those who will buy the cheap level CEU kind of stuff, and do a quick read on something and take a test and not really spend the time to investigate what was being offered. And maybe some of the quality of that they're learning is really not up to date either. Versus those of us who will go to con ed meetings, we'll do things online. Now there's a lot of opportunity. PBS shows a lot of things out ABQ has a lot of things. Michael Weinper (00:59:35): I'm a member of the orthopedic session section and the oncology section. They have lots of stuff going on that, yeah, there's too much of it. There's just like there's like education overload. So you have to be selective, but do choose things that I think will be beneficial to you. And that are evidence-based. So it brings back to the evidence based part because too often I've heard people get up at meetings and start to talk about things. And then when challenged on what's the word, what's the basis of your comments? They sort of stammered. And they said they gave answers that weren't really appropriate. So we do need more focus on, on lifelong, which we're mandated to do, but some people take the easy way out. You know, people, we all have people we know who will take the high road and others who take the low road and the low road may be the easier road that may not be the get to the right end. Michael Weinper (01:00:29): So we want to challenge ourselves to learn more each day. And I can tell you that when I went back and got my DPT, I thought it would be fairly easy. And some of the things that I was exposed to, I'd already learned in my master's level, but I can tell you a lot of things that I learned were new concepts that I had never even thought about. And that goes to the idea of this lifelong learning and evidence based practice you learn, most of you learned in school all about evidence-based theory and practice, and some of you embraced it very well and other views sort of gone a different path. So I would say, take a step back and look at the research that's coming out. There's all kinds of journals. And that's another thing that I have to digress on a moment. Michael Weinper (01:01:17): And that is, here's a question for each of you, how many journals or publications that are healthcare oriented, do you read or subscribed to, if you say only PT, then I think you're making a big mistake because there's so much literature and so many things that are appropriate for what we do in our field. And to validate what we do in other journals and research is being done that we miss the boat by not looking at it at other professional journals or other modes of information, or even attending meetings for physicians and so on. I used to specialize in the treatment of hand injuries. And so I would go to the society for hand search and they actually had a PT sub, a PTO to see subset of that that my friend, dr. Susan Mike Clovis, was very involved in and she got me involved and I would listen to physicians. Michael Weinper (01:02:18): We collegial meetings where PTs and physicians would interact to try and come up with the best ideas. And many of us don't really have any contact with physicians, except when we're talking to them in the halls of the hospital or when we're going out to market them, or we're trying to take lunch to them. We don't talk really about concepts and about theory. And what do you base this upon? And what can we do to learn more about the benefits of what we do? And that gets us to the idea of each of us having the challenge to do some research, research is fascinating. It doesn't pay a lot, but you can still do research in your clinic. You can be parts of research projects. If you just look for them, is they're out there to take advantage of. And if you do that, it opens your eyes so much more. Stephanie Weyrauch (01:03:09): And I think a lot of the things that you've touched on kind of goes with the last element of vision 2020 and that's professionalism. So when the house of delegates originally defined what professionalism means in vision 2020, it's that we as physical therapists and physical therapist assistants are consistently demonstrating core values by aspiring to and wisely applying principles of altruism, excellence, caring, ethics, respect, communication, and accountability by working with other professionals to optimize health and wellness in individuals and in communities. So obviously one of the bigger focus is of APTA has been this optimizing society or optimizing movement to impact society. And we've been kind of taking more of a population health kind of perspective, trying to get out of the silo, physical therapy and move more into the interdisciplinary healthcare, healthcare, professional realm. Where would you say we are? As far as our professionalism goes in 2020, compared to where we were in 2000? Michael Weinper (01:04:15): Oh boy, I think many of us have because of our increased education, gotten more credibility with the medical profession. They tend to listen to us more rather than just seeing us as a technical entity or a technician versus a professional. Although I can tell you still today, physicians oftentimes don't see the benefit that we do even orthopedist. And we have come a long way in some with so many physicians, but we've missed the boat with others. I think it's critical than medical stuff, schools, especially if you're doing an orthopedic residency, that's a resident spend time with a PT. I was in a well known physician, internationally known physicians office recently with my wife who, when she had her shoulder surgery. And he has no to fellows at all times. And occasionally a PT will visit and come in and, and be there not to get paid, but just to talk and work with the physicians, educate the physicians and the younger ones, the fellows who are going to be out there real soon in their own practice. Michael Weinper (01:05:34): We need to do a better job of educating physicians. I said that a little bit earlier, but I really mean it. We can do it when they're in school, when they're doing their fellowships, we can invite them into our practices. We can go to doctor's offices and shadow them much more than we do. We can go into surgery with physicians and talk to them while they're there doing their procedure, learning why they're doing their procedure. And sometimes a light bulb will go on in your head say, Oh, I get that. And that's, I think there's something I could do a little bit differently with like, with your patients when I'm treating them by seeing what you're doing surgically and listening to what your concepts are. So I think there's a lot more collegial realism of that goes to being a professional. And to that point, if you don't see yourself as a professional others, aren't going to see you as fun and too many of us lose track of the fact that we are in it. Michael Weinper (01:06:27): When you say it's a profession, a profession requires one of the key points of any profession is that you learn, you keep current and you give back to society. And giving back to society means more than just treating people. It means educating the population, doing things from a wellness standpoint or avoidance of injury. I guess going back to my public health days where one of the key things is getting people not to have to see you clinically as a post op or whatever, but helping people to avoid surgery and do things the proper way. Ergonomics for example, is a good, good use of our skills and what we've learned as I sit up in my chair properly. And we doing things that people just don't think about. And when we break away from just being the PT, treating person and branch out to media with other professions, talking to them a